Three-year interval for endoscopic screening may reduce the mortality in patients with gastric cancer
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Endoscopic screening has been adopted in South Korea for the national screening of gastric cancer (GC). This study aimed to assess the effect on overall survival of GC patients and determine the optimal endoscopic screening interval.
The baseline characteristics and overall survival of GC patients treated at the National Cancer Center, Korea, between 2010 and 2016 were compared between those without a history of endoscopic evaluation (group N) and those in whom the interval between the last endoscopic evaluations and diagnosis of GC was ≤ 1, 1–2, 2–3, 3–4, or > 4 years (groups 1–5, respectively).
A total of 2362 patients met the criteria for the study (1060 in group N and 1302 in groups 1–5). More patients in groups 1–5 were diagnosed with stage I GC (83.7, 83.7, 71.8, 78.2, and 71.6%, respectively) than in group N (62.4%, P < 0.001) and were treated endoscopically (38.8, 33.8, 24.7, 21.8, and 15.5%, respectively, vs. 13.5%; P < 0.001). Group 2 had less-advanced tumor stages (P = 0.001) and was more likely to have received endoscopic treatments (P = 0.026) than group 3. Hazard ratios for death were significantly lower in groups 2 (0.45; 95% confidence interval [CI], 0.32–0.64) and 3 (0.57; 95% CI, 0.33–0.98) than in group N; the decrease was not significant in group 4 (0.49, 95% CI, 0.20–1.20).
Endoscopic screening every 3 years may reduce the mortality of GC patients, though screenings at least every 2 years may benefit patients with less-advanced stages.
KeywordsEndoscopic screening program Overall survival Gastric cancer Screening
SIC contributed to data acquisition, analysis and interpretation of data, and drafting of the manuscript; BP contributed to statistical analysis, interpretation of data, and drafting of the manuscript; JJ contributed to statistical analysis, interpretation of data, administrative support; Y-IK contributed to material support and critical revision of the manuscript for important intellectual content; JYL contributed to material support and critical revision of the manuscript for important intellectual content; CGK contributed to material support and critical revision of the manuscript for important intellectual content; IJC contributed to material support and critical revision of the manuscript for important intellectual content; M-CK contributed to material support and critical revision of the manuscript for important intellectual content; S-JC contributed to study concept and design, critical revision of the manuscript for important intellectual content, obtained funding, and study supervision.
This study was supported by a Grant from the National Cancer Center, Korea (#1610160-2) and the National Research Foundation, Korea (#NRF-2016R1A2B1010377).
Compliance with ethical standards
Dr. Sang Il Choi, Ms. Boram Park, Drs. Jungnam Joo, Young-Il Kim, Jong Yeul Lee, Chan Gyoo Kim, Il Ju Choi, Myeong-Cherl Kook, and Soo-Jeong Cho have no conflict of interest or financial ties to disclose.
- 7.Hamashima C, Ogoshi K, Okamoto M, Shabana M, Kishimoto T, Fukao A (2013) A community-based, case-control study evaluating mortality reduction from gastric cancer by endoscopic screening in Japan. PLoS ONE 8(11):e79088. https://doi.org/10.1371/journal.pone.0079088 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Hosokawa O, Miyanaga T, Kaizaki Y, Hattori M, Dohden K, Ohta K, Itou Y, Aoyagi H (2008) Decreased death from gastric cancer by endoscopic screening: association with a population-based cancer registry. Scand J Gastroenterol 43(9):1112–1115. https://doi.org/10.1080/00365520802085395 CrossRefPubMedGoogle Scholar
- 10.Chung SJ, Park MJ, Kang SJ, Kang HY, Chung GE, Kim SG, Jung HC (2012) Effect of annual endoscopic screening on clinicopathologic characteristics and treatment modality of gastric cancer in a high-incidence region of Korea. Int J Cancer 131(10):2376–2384. https://doi.org/10.1002/ijc.27501 CrossRefPubMedGoogle Scholar
- 11.Choi KS, Jun JK, Suh M, Park B, Noh DK, Song SH, Jung KW, Lee HY, Choi IJ, Park EC (2015) Effect of endoscopy screening on stage at gastric cancer diagnosis: results of the National Cancer Screening Programme in Korea. Br J Cancer 112(3):608–612. https://doi.org/10.1038/bjc.2014.608 CrossRefPubMedGoogle Scholar
- 15.Nam SY, Choi IJ, Park KW, Kim CG, Lee JY, Kook MC, Lee JS, Park SR, Lee JH, Ryu KW, Kim YW (2009) Effect of repeated endoscopic screening on the incidence and treatment of gastric cancer in health screenees. Eur J Gastroenterol Hepatol 21(8):855–860. https://doi.org/10.1097/MEG.0b013e328318ed42 CrossRefPubMedGoogle Scholar
- 18.Eom BW, Kim YI, Kim KH, Yoon HM, Cho SJ, Lee JY, Kim CG, Kook MC, Kim YW, Nam BH, Ryu KW, Choi IJ (2017) Survival benefit of additional surgery after noncurative endoscopic resection in patients with early gastric cancer. Gastrointest Endosc 85(1):155–163 e153. https://doi.org/10.1016/j.gie.2016.07.036 CrossRefPubMedGoogle Scholar
- 21.Kim YW, Yoon HM, Yun YH, Nam BH, Eom BW, Baik YH, Lee SE, Lee Y, Kim YA, Park JY, Ryu KW (2013) Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial (COACT 0301). Surg Endosc 27(11):4267–4276. https://doi.org/10.1007/s00464-013-3037-x CrossRefPubMedGoogle Scholar
- 22.Jun JK, Choi KS, Lee HY, Suh M, Park B, Song SH, Jung KW, Lee CW, Choi IJ, Park EC, Lee D (2017) Effectiveness of the Korean National Cancer Screening Program in reducing gastric cancer mortality. Gastroenterology 152(6):1319–1328 e1317. https://doi.org/10.1053/j.gastro.2017.01.029 CrossRefPubMedGoogle Scholar
- 27.Lim SH, Kwon JW, Kim N, Kim GH, Kang JM, Park MJ, Yim JY, Kim HU, Baik GH, Seo GS, Shin JE, Joo YE, Kim JS, Jung HC (2013) Prevalence and risk factors of Helicobacter pylori infection in Korea: nationwide multicenter study over 13 years. BMC Gastroenterol 13:104. https://doi.org/10.1186/1471-230X-13-104 CrossRefPubMedPubMedCentralGoogle Scholar
- 29.de Vries AC, van Grieken NC, Looman CW, Casparie MK, de Vries E, Meijer GA, Kuipers EJ (2008) Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology 134(4):945–952. https://doi.org/10.1053/j.gastro.2008.01.071 CrossRefPubMedGoogle Scholar