Severity of chronic atrophic gastritis and subsequent gastric cancer occurrence: a 10-year prospective cohort study in Japan

Chronic atrophic gastritis is regarded as a predisposing factor for gastric cancer associated with Helicobacter pylori infection, and its severity is suggested to be a key influence on gastric cancer risk. Our purpose was to elucidate chronological change in cumulative risk of gastric cancer occurrence with various degrees of chronic atrophic gastritis by long-term follow-up. A total of 5373 subjects without cancer or resected stomachs who underwent gastroscopic examination and completed a life-style questionnaire between 1985-1989 were prospectively followed until December 1999. Relative risks of gastric cancer associated with baseline endoscopic findings were estimated using hazard ratios and their 95% confidence intervals with the Cox proportional hazard model, adjusting for gender, age and gastric cancer family history. After an average of 10 years of followup, 117 gastric cancer cases were identified. The risk was greatest among the subjects with moderate atrophy at baseline (hazard ratio: 2.22) and 4-6 years of follow-up (hazard ratio: 4.6-5.0). After this time point, risk attenuation with the length of follow-up period was observed. Our study gives the supportive evidence to the hypothesis that incomplete chronic atrophic gastritis and the processes occurring in atrophy are associated with development of gastric cancer. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.