EARLY AND ADVANCED GASTRIC-CANCER IN THE FOLLOW-UP OF MODERATE AND SEVERE GASTRIC DYSPLASIA PATIENTS - A PROSPECTIVE-STUDY

The role of gastric epithelial dysplasia (GED) as a biological and mor phological precursor of gastric cancer has been widely investigated, b ut few studies have prospectively evaluated the risk of its evolution into gastric cancer. In 1985, a prospective multicenter follow-up stud y was undertaken on patients with high-grade (moderate or severe) GED. The study involved 49 patients, with a follow-up currently averaging 18.8 months (range: 1-70) and a mean number of 4 endoscopies (range: 2 -10). Follow-up was abandoned when 2 subsequent control endoscopies an d a 1-year period were negative for GED, or when neoplasia was detecte d. Gastric cancer was diagnosed in 16 cases (33 %). The cancer was det ected at an early stage in 10 patients (62 %). Eleven cases (59 %) wer e diagnosed within 1 year of follow-up and 5 cases after 13, 18, 21, 2 4 and 39 months, respectively. Cancer was associated with 36 % of mode rate GED cases and with 80 % of severe cases. Dysplastic changes were no longer detectable at follow-up in 27 % of the moderate cases and in 10 % of the severe cases. The relative risks for the two lesions bein g associated with or evolving into gastric cancer were 26 and 132, res pectively. In conclusion, high-grade (moderate or severe) GED is frequ ently associated with or evolves into gastric cancer. The follow-up of patients considerably enhances the chances of diagnosing gastric canc er in its early stages, thus making such an approach mandatory.