Optimal age to stop surveillance in the older population at risk for gastric cancer

Aims In the Netherlands, patients with gastric premalignant lesions (GPL) are under endoscopic surveillance to detect gastric cancer (GC) at an early stage. However, no consensus exists until which age the yield of surveillance is sufficient to warrant surveillance endoscopies in a growing fragile population. Therefore, the aim of this study is to compare the age-specific incidence rates of GC in the surveillance population with the standard Dutch population and propose an optimal age to end gastric cancer surveillance.

Methods The ongoing Progression and Regression of Precancerous Gastric Lesions (PROREGAL) study consists of GPL patients under surveillance according to the MAPSII guidelines. All newly diagnosed GCs between 2009-2023 were identified by reviewing medical records and linkage to the Netherlands Cancer Registry (NCR). The cumulative incidence of GC over a 10-year follow-up period was calculated using a cumulative incidence model. The standard incidence rate (SIR) was calculated by dividing the number of observed cases of high-grade dysplasia (HGD) and gastric cancers by the number of expected cases based on the general population. Incidence rates (IR), stratified by age at diagnosis and stage, were compared with the general population.

Results A total of 373 patients were included, 1.6% progressed towards HGD/GC (2 HGD, 6 GC) in 1509.4 person-years of follow-up. After 10 years of follow-up, the cumulative incidence of GC was 2.2%. The SIR was 37.4 (CI -23.9 – 73.7). In the surveillance population the incidence rate (IR) per 1000 person years (py) for GC decreased with age, with an IR of 13.65 (45.3%) in age group 30-44; 5.52 (18.3%) in 45-59; 7.26 (24.1%) in 60-74 and 3.72 (12.3%) in patients over 75 years of age. The majority of these GCs were detected in early stages, with an IR per 1000 py of 1.59 (25.0%) in stage 0, 3.18 (50.0%) in stage I, 0.80 (12.5%) in stage II, 0.80 (12.5%) in stage III, and 0 (0%) in stage IV. In contrast, the IR per 100000 py in the general population were in stage 0 0.15 (2.2%); stage I 0.85 (12.2%); stage II 1.08 (15.5%); stage III 1.11 (16.0%) and stage IV 2.99 (43.0%) and unknown stage 0.77 (11.1%) [1].

Conclusions The age of diagnosis of GC shows a declining trend in the surveillance cohort, especially in those patients over 75. Therefore, we propose to end gastric cancer surveillance in patients over 75 years of age. Despite the low cumulative incidence, the high SIR and detection of GC at more favorable stage indicates that surveillance may still be warranted in high-risk GPL patients.

Publication History

Article published online:
27 March 2025

• References

• 1 Pimentel-Nunes P, Libânio D, Marcos-Pinto R, Areia M, Leja M, Esposito G, Garrido M, Kikuste I, Megraud F, Matysiak-Budnik T, Annibale B, Dumonceau JM, Barros R, Fléjou JF, Carneiro F, van Hooft JE, Kuipers EJ, Dinis-Ribeiro M.. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy 2019; 51 (04): 365-388 Epub 2019 Mar 6. PMID: 30841008.