GASTRIC EPITHELIAL DYSPLASIA - HOW CLINICOPATHOLOGICAL BACKGROUND RELATES TO MANAGEMENT

Background. Gastric epithelial dysplasia (GED) in metaplastic mucosa i s considered the most advanced preinvasive lesion in the multistep mor phogenesis of intestinal-type gastric cancer (GC). The rate of GED's e volution into GC is still under debate and probably is related to path ologic and clinical parameters other than the dysplasia itself. The ai m of this study was to evaluate whether clinical aspects (sex and age) and/or morphologic variables (GED grade, coexisting atrophic gastriti s) are relevant to the outcome of dysplasia, with a view toward initia ting the establishment of a rational follow-up protocol for practical GED management. Methods. Ninety-three patients harboring GED (G1: 56, G2:34, G3:18) were followed for more than 12 months according to a pre viously-agreed protocol. Regression, progression, or evolution into GC were detected for each grade of GED. Multivariate analysis was used t o check the independence of clinical and pathologic variables in the p rogression of GED into more severe dysplastic lesions and/or as risk f actors for evolution into GC, Results. Age, male sex, GED grade and gr ade of coexisting atrophic gastritis proved independent risk factors f or GED progression, with no significant interactions. Only GED grade ( G2 and G3) was significantly associated with carcinomatous evolution. In G1-GED, age and the grade of coexisting atrophy proved to be indepe ndent risk factors for carcinomatous evolution. Conclusions. In G1-GED , more stringent follow-up should be recommended for older patients wi th coexisting high grade atrophic gastritis; stringent follow-up is al ways mandatory for G2-GED; and a surgical approach is justified in G3- GED.