Risk of Adenocarcinoma in Gastric Atrophy and Intestinal Metaplasia: a Systematic Review and Meta-analysis

Authors

Spence AD1, Cardwell CR1, McMenamin UC1, Hicks BM1, Johnston BT2, Murray LJ1, Coleman HG1

Departments / Institutions

1Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom 2Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom

Publication Date

Autumn 2016

Introduction

Gastric adenocarcinoma (GC) is the third leading cause of death from cancer worldwide. The mucosal changes of gastric atrophy (GA) and intestinal metaplasia (IM) are recognised pre-cancerous lesions. Accurate quantification of progression risk from GA / IM to GC is necessary to determine the feasibility of surveillance programmes.

Aims

This systematic review and meta-analysis examines the risk of GC in patients with GA or IM.

Methods

Four databases were searched for relevant articles (EMBASE, MEDLINE, Web of Science, Cochrane Library) published up to 10th June 2016 that investigated the risk of developing GC in individuals with GA or IM. Independent data extractors assessed articles according to inclusion/exclusion criteria. Random effects meta-analyses were conducted to generate pooled estimates of cancer incidence.

Results

Fifteen relevant articles were identified, of which there were eight studies of GC incidence in GA and nine of GC incidence in IM patient populations (two articles investigated both GA and IM). The pooled estimate of GC in patients with GA and IM was 2.94 (Figure 1) and 2.63 (Figure 2) per 1,000 person-years, respectively, but there was marked heterogeneity for both (I2=94%, heterogeneity P<0.001; and I2=93%, heterogeneity P<0.001, respectively).

Conclusion

The overall annual incidence rate of GC in patients with GA or IM is 0.29% and 0.26%, respectively. The substantial heterogeneity supports the need for more robust studies.