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
Processing time: 66 Days and 22.7 Hours
ARTICLE HIGHLIGHTS
Research background

Type I gastric neuroendocrine neoplasms (gNENs) in chronic autoimmune gastritis (AIG) are increasingly being diagnosed, but no accurate data are available.

Research motivation

To date, no risk factors for malignant transformation of AIG into NENs have been identified. Their identification may significantly help to optimize endoscopic follow-up of AIG.

Research objectives

The main objective was to evaluate the incidence and prevalence of type I gNENs in a cohort of AIG patients. Secondly, the study aimed to identify potential risk factors for malignant transformation of AIG.

Research methods

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

Research results

Among 176 included patients, after 1032 person-years, 33 patients developed a total of 50 gNEN type I, with an incidence rate of 0.057 person-years, corresponding to an annual cumulative incidence of 5.7%. Gastrin levels were significantly higher in AIG patients who developed gNENs [median 992 pg/mL, [interquartile range (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.

Research conclusions

Type I gNENs are a frequent complication of AIG. Hypergastrinemia plays a trophic role in the gastric mucosa, but due to its low specificity, it cannot be a noninvasive marker of early diagnosis of gNEN in AIG.

Research perspectives

Further efforts are needed to identify effective strategies for individualizing endoscopic follow-up of AIG patients for early diagnosis and treatment of superimposed neuroendocrine lesions.