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The Incidence of Gastric Adenocarcinoma Among Patients With Gastric Intestinal Metaplasia

A Long-term Cohort Study

Lee, Teng-Yu MD, PhD; Wang, Ren-Ching MD; Lee, Yi-Chia MD, PhD; Lin, Jaw-Town MD, PhD; Ho, Hsiu J. PhD; Hsieh, Mu-Chih MS; Wu, Chun-Ying MD, PhD

Journal of Clinical Gastroenterology: August 2016 - Volume 50 - Issue 7 - p 532–537
doi: 10.1097/MCG.0000000000000406
ALIMENTARY TRACT: Original Articles

Background and Aims: Gastric intestinal metaplasia (IM) has been known as a premalignant condition, but estimates of its cancer risk vary widely. We aimed to analyze cancer risk of gastric IM by a long-term cohort study.

Methods: We conducted a hospital-based study that included all patients with gastric IM between 1992 and 2010, and the development of gastric adenocarcinoma was evaluated until July 2011. Patients developing gastric cancer ≤180 days after the index diagnosis of IM were excluded. The incidence rate, the cumulative incidence, and the standardized incidence ratio (SIR) of gastric cancer were determined, and hazard ratios (HRs) of risk factors were calculated.

Results: We identified 7059 patients with a median follow-up duration of 5.1 years, and 81 patients developed gastric adenocarcinoma during the study period. The 5-, 10-, and 15-year cumulative incidences of gastric cancer were 0.9% [95% confidence interval (CI), 0.6-1.1), 2.0% (95% CI, 1.5-2.6), and 3.0% (95% CI, 2.0-4.0), respectively. On multivariate analysis, older age (eg, 75 y and above; HR=7.4; 95% CI, 2.8-19.6), low-grade dysplasia (HR=4.0; 95% CI, 2.1-7.9), and high-grade dysplasia (HR=18.8; 95% CI, 9.0-39.5) were independent risk factors. As compared with the risk in the general population, the SIR of gastric cancer among patients with gastric IM was 2.5 (95% CI, 2.0-3.1). However, the SIR was only 2.0 (95% CI, 1.5-2.6) in the nondysplasia subgroup, but was up to 35.2 (95% CI, 15.2-69.4) in the high-grade dysplasia subgroup.

Conclusions: Gastric IM is an important risk factor for gastric cancer, but surveillance should be arranged only for those at an especially high risk.

*Division of Gastroenterology

Departments of Pathology and Laboratory Medicine

#Computer information, Taichung Veterans General Hospital

Department of Medicine, Chung Shan Medical University

††Department of Public Health and Graduate Institute of Clinical Medicine Science, China Medical University

‡‡Department of Life Sciences, National Chung-Hsing University, Taichung

§Department of Internal Medicine, College of Medicine, National Taiwan University

**Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei

School of Medicine, Fu Jen Catholic University, New Taipei City

Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan

Supported by a grant from Taichung Veterans General Hospital (grant number: TCVGH-1013304C).

The authors declare that they have nothing to disclose.

Address correspondence to: Chun-Ying Wu, MD, PhD, Division of Gastroenterology and Hepatology, Taichung Veterans General Hospital, 1650, Sec. 4, Taiwan Boulevard, Taichung 40705, Taiwan (e-mail:

Received May 6, 2015

Accepted July 24, 2015

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