Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2023; 15(8): 1451-1460
Published online Aug 15, 2023. doi: 10.4251/wjgo.v15.i8.1451
Incidence and prevalence of gastric neuroendocrine tumors in patients with chronic atrophic autoimmune gastritis
Sara Massironi, Camilla Gallo, Alessandra Elvevi, Marta Stegagnini, Lorenzo Andrea Coltro, Pietro Invernizzi
Sara Massironi, Camilla Gallo, Alessandra Elvevi, Marta Stegagnini, Lorenzo Andrea Coltro, Pietro Invernizzi, Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, School of Medicine, Monza 20900, Italy
Author contributions: Massironi S supervised the whole article preparation process, revised the manuscript, and performed most of the data analysis; Gallo C wrote the manuscript, created the figure and tables, revised the whole article, and contributed to data analysis; Elvevi A contributed to writing the manuscript and revised the article; Stegagnini M contributed to writing the manuscript and checking the references; Coltro LA contributed to data analysis; Invernizzi P revised the entire article preparation process.
Institutional review board statement: The Brianza Ethics Committee, after having examined the documentation referred to in the attached list, acknowledged that the research project complies with the ethical principles stated in the Declaration of Helsinki and subsequently revised and integrated, as well as with the rules of good clinical practice, reported in the Decree of Ministry of Health of 15/07/97.Therefore, the Ethics Committee in its meeting of 03/24/2022, in accordance with circular letter no. 6 of 09/02/02, paragraph2.4, and with the AIFA Resolution of 03/20/08 expressed a favorable opinion on the execution of the forementioned study, under the responsibility of the above-mentioned investigator.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: Authors have nothing to declare.
Data sharing statement: Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: Sara Massironi, MD, PhD, Chief Physician, Doctor, Medical Assistant, Research Scientist, Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca School of Medicine, Via G.B. Pergolesi 33, Monza 20900, Italy. sara.massironi@libero.it
Received: June 4, 2023
Peer-review started: June 4, 2023
First decision: June 16, 2023
Revised: June 23, 2023
Accepted: July 7, 2023
Article in press: July 7, 2023
Published online: August 15, 2023
Abstract
BACKGROUND

The incidence of type I gastric neuroendocrine neoplasms (gNENs) has increased significantly over the past 50 years. Although autoimmune gastritis (AIG) increases the likelihood of developing gNENs, the exact incidence and prevalence of this association remain unclear.

AIM

To evaluate the incidence and prevalence of type I gNENs in a cohort of patients with a histological diagnosis of AIG.

METHODS

Patients with a histological diagnosis of AIG were enrolled between October 2020 and May 2022. Circulating levels of CgA and gastrin were assessed at enrollment. Included patients underwent regular endoscopic follow-up to detect gastric neoplastic lesions, enterochromaffin-like (ECL) cell hyperplasia, and the development of gNEN.

RESULTS

We included 176 patients [142 women (80.7%), median age 64 years, interquartile range (IQR) 53–71 years] diagnosed with AIG between January 1990 and June 2022. At enrollment. One hundred and sixteen patients (65.9%) had ECL hyperplasia, of whom, 29.5% had simple/linear, 30.7% had micronodular, and 5.7% had macronodular type. The median follow-up time was 5 (3–7.5) years. After 1032 person-years, 33 patients developed a total of 50 type I gNENs, with an incidence rate of 0.057 person-years, corresponding to an annual cumulative incidence of 5.7%. Circulating CgA levels did not significantly differ between AIG patients who developed gNENs and those who did not. Conversely, gastrin levels were significantly higher in AIG patients who developed gNENs [median 992 pg/mL IQR = 449–1500 vs 688 pg/mL IQR = 423–1200, P = 0.03]. Calculated gastrin sensitivity and specificity were 90.9% and 1.4%, respectively, with an overall diagnostic accuracy of 30% and a calculated area under the gastrin receiver operating characteristic curve (AUROC or AUC) of 0.53.

CONCLUSION

Type I gNENs are a significant complication in AIG. Gastrin’s low diagnostic accuracy prevents it from serving as a marker for early diagnosis. Effective strategies for early detection and treatment are needed.

Keywords: Atrophic gastritis, Autoimmune gastritis, Gastrin, Gastric neuroendocrine tumors

Core tip: Type I gastric neuroendocrine neoplasms (gNENs) in chronic autoimmune gastritis (AIG) are increasingly diagnosed, but no accurate data are available. Noninvasive biomarkers of gNENs in AIG have not yet been identified. According to our results, a non-negligible annual cumulative gNEN incidence of 5.7% was revealed, and among all considered variables, only gastrin proved to have significantly higher median circulating levels in patients who developed gNENs compared to AIG patients without lesions; nevertheless, with low diagnostic accuracy. Further efforts are needed to identify effective strategies for individualizing endoscopic follow-up of AIG patients, to achieve early diagnosis and treat superimposed neuroendocrine lesions.