Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Comorbidities related to metachronous recurrence for early gastric cancer in elderly patients
Ying Xiang, Ying Yuan, Zhen-Yu Wang, Yan-Mei Zhu, Wen-Ying Li, Qian-Ge Ye, Ya-Nan Wang, Qi Sun, Xi-Wei Ding, Faraz Longi, De-Hua Tang, Gui-Fang Xu
Ying Xiang, Yan-Mei Zhu, Wen-Ying Li, Gui-Fang Xu, Department of Gastroenterology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing 210008, Jiangsu Province, China
Ying Yuan, Zhen-Yu Wang, Xi-Wei Ding, De-Hua Tang, Gui-Fang Xu, Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Qian-Ge Ye, Department of Gastroenterology, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing 210008, Jiangsu Province, China
Ya-Nan Wang, Gui-Fang Xu, Department of Gastroenterology, Hospital Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
Qi Sun, Department of Pathology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Faraz Longi, Feinberg School of Medicine, Northwestern University, Chicago, IL 60601, United States
Co-first authors: Ying Xiang and Ying Yuan.
Author contributions: Xiang Y, Yuan Y, and Wang ZY contributed to collection of samples, statistical analysis and writing of the manuscript; Zhu YM, Ye QG, Li WY, and Wang YN contributed to acquisition of data and drafting the article; Sun Q contributed to endoscopic and pathological diagnosis and supervision of the study; Ding XW and Tang DH contributed to analysis and interpretation of data; Longi F contributed to the manuscript review and editing; Xu GF contributed to original idea, design of the study, funding acquisition, and final approval of the version.
Supported by the National Natural Science Foundation of China, No. 81572338 and No. 82170548; C-class-sponsored research project of the Jiangsu Provincial Six Talent Peaks, No. WSN-078; Jiangsu Province “333 High-level Talents Training Project”, No. 2016-III-0126; the Jiangsu Provincial Key Research and Development Program, No. BE2021601; and the Postgraduate Research and Practice Innovation Program of Jiangsu Province, No. SJCX24_1037.
Institutional review board statement: All procedures performed in studies involving human participants were approved by the Human Ethics Review Committees of Nanjing Drum Tower Hospital (No. 2024-395-01). This research was retrospective and the data on patients were anonymous, and the requirement for informed consent was waived by the Ethics Committee.
Informed consent statement: All data were anonymous, and patient images were not reported. Verbal informed consent for publication was obtained from each patient or their guardian. Verbal informed consent was obtained after a series of telephone interviews with the patients.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Gui-Fang Xu, PhD, Chief Doctor, Department of Gastroenterology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu Province, China.
xuguifang@njglyy.com
Received: July 24, 2024
Revised: September 15, 2024
Accepted: December 5, 2024
Published online: March 16, 2025
Processing time: 232 Days and 10.6 Hours
BACKGROUND
A significant association between increased age and an increased risk of metachronous gastric cancer (MGC) following curative endoscopic submucosal dissection (ESD) has previously been reported.
AIM
To determine risk factors for the metachronous occurrence of early gastric cancer (EGC) in elderly individuals.
METHODS
This retrospective cohort study comprised 653 elderly patients (aged ≥ 65 years) who underwent curative ESD for EGC between January 2014 and June 2020 at Nanjing Drum Tower Hospital. Comprehensive analyses were conducted to compare lifestyle habits, comorbidities, and Helicobacter pylori (H. pylori) infections as potential indicators.
RESULTS
During a median follow-up of 38 months, 46 patients (7.0%, 20.46/1000 person-years) developed MGC in the elderly cohort. The cumulative incidences of MGC at 2, 3, and 5 years were 3.3%, 5.3%, and 11.5%, respectively. In multivariate Cox regression analyses, the independent risk factors for MGC included metabolic dysfunction-associated steatotic liver disease (MASLD) [hazard ratio (HR) = 2.44, 95% confidence interval (CI): 1.15-5.17], persistent H. pylori infection (HR = 10.38, 95%CI: 3.36-32.07), severe mucosal atrophy (HR = 2.71, 95%CI: 1.45-5.08), and pathological differentiation of EGC (well/moderately differentiated vs poorly differentiated: HR = 10.18, 95%CI: 1.30-79.65). Based on these risk factors, a risk stratification system was developed to categorize individuals into low (0-1 point), intermediate (2-3 points), and high (4-8 points) risk categories for MGC, with cumulative incidence rates of 12.3%, 21.6%, and 45%, respectively.
CONCLUSION
Among elderly individuals, MASLD, persistent H. pylori infection, severe mucosal atrophy, and well/moderately differentiated EGC were associated with an increased risk of MGC. Elderly patients are recommended to adopt healthy lifestyle practices, and undergo regular endoscopic screening and H. pylori testing after curative ESD for EGC.
Core Tip: This study retrospectively examined the risk factors for the metachronous occurrence of early gastric cancer (EGC) in elderly individuals. The study findings indicated that metabolic dysfunction-associated steatotic liver disease, persistent Helicobacter pylori infection, severe mucosal atrophy, and well/moderately differentiated EGC were associated with a higher risk of metachronous gastric cancer.
