Cancer Res Treat.  2018 Apr;50(2):582-589. 10.4143/crt.2017.048.

Effectiveness of Gastric Cancer Screening on Gastric Cancer Incidence and Mortality in a Community-Based Prospective Cohort

Affiliations
  • 1Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea. suepark@snu.ac.kr
  • 2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 3Cancer Research Center, Seoul National University, Seoul, Korea.
  • 4Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • 5The Armed Forces Capital Hospital, Seongnam, Korea.

Abstract

PURPOSE
This study was performed to investigate the effectiveness of gastric cancer (GC) screening methods in a community-based prospective cohort of the Korean Multi-center Cancer Cohort (KMCC) with over a 10-year follow-up.
MATERIALS AND METHODS
A total 10,909 and 4,773 subjects from the KMCC with information on gastroendoscopy (GE) and upper gastrointestinal series (UGIS) were included in this study. Cox proportional hazard model adjusted for age, sex, Helicobacter pylori infection, cigarette smoking, and alcohol drinking was used to estimate the hazard ratios (HRs) and 95% confidence interval (CI).
RESULTS
The GE screened subjects had almost half the risk of GC-specific death than that of unscreened subjects (HR, 0.58; 95% CI, 0.36 to 0.94). Among the GC patients, GE screenees had a 2.24-fold higher survival rate than that of the non-screenees (95% CI, 1.61 to 3.11). In particular, GE screenees who underwent two or more screening episodes had a higher survival rate than that of the non-screenees (HR, 13.11; 95% CI, 7.38 to 23.30). The effectiveness of GE screening on reduced GC mortality and increased survival rate of GC patients was better in elderly subjects (≥ 65 years old) (HR, 0.47; 95% CI, 0.24 to 0.95 and HR, 8.84; 95% CI, 3.63 to 21.57, respectively) than that in younger subjects (< 65 years old) (HR, 0.66; 95% CI, 0.34 to 1.29 and HR, 1.83; 95% CI, 1.24 to 2.68, respectively). In contrast, UGIS screening had no significant relation to GC mortality and survival.
CONCLUSION
The findings of this study suggest that a decreased GC-specific mortality and improved survival rate in GC patients can be achieved through GE screening.

Keyword

Stomach neoplasms; Cohort studies; Mortality; Gastrointestinal endoscopy; Gastroscopy

MeSH Terms

Aged
Alcohol Drinking
Cohort Studies*
Endoscopy, Gastrointestinal
Follow-Up Studies
Gastroscopy
Helicobacter pylori
Humans
Incidence*
Mass Screening*
Mortality*
Proportional Hazards Models
Prospective Studies*
Smoking
Stomach Neoplasms*
Survival Rate
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