- Email: [email protected]
Screening for esophageal neoplasia in patients with head and neck cancer?
3074 Screening For Esophageal Neoplasia In Patients With Head And Neck Cancer? Hans Scheruebl, Bernd Von Lampe, Siegbert Faiss, Medical Clin I, Benjamin Franklin Clinics, FU Berlin, Berlin Germany; Peter Bohlmann, ENT Dept, Berlin Germany; Thomas Plath, Oept of Maxillofacial Plastic Surg, Berlin Germany; Hans Dieter Foss, Jnst of Pathology, Benjamin Franklin Clinics, FU Berlin, Berlin Germany; Hans Scherer, ENT Dept, Berlin Germany; Bodo Hoffmeister, Dept of Maxillofacial Plastic Surg, Berlin Germany; Harald Stein, Inst of Pathology, Benjamin Franklin Clinics, FU Berlin, Berlin Germany; Peter Daeubler, Martin Zeitz, Ernst-Otto Rieckeo, Medical Clin I, Benjamin Franklin Clinics, Fu Berlin, Berlin Germany
Background: Due to advanceddiseaseat the time of diagnosis the prognosis of esophageal cancer is generally poor. As mass screening for esophagealcancer is neither feasible nor reasonable, groups of people that are at high risk should be identified and surveiged. The aim of this study was to define the risk of esophagealcancer in patients with (previous) head and neck cancer. Methods: From August 1999 to November2000 120 patientswith (previous) head and neck cancer were prospectively screenedfor esophagealcancer by high-resolution videoesophagoscopy,Even in a macroscopicallynormal appearingesophagus4 biopsy specimen were taken every 3 cm throughout the length of the squamous esophagus in the last 70 of the 120 patients. Results: Low-, moderate- or high-grade squamous cell dysplesiawas detected histologically in 7 of the 70 patients (10.0%). Esophagealsqoamous cell cardnoma was diagnosed in 7 of the 120 patients (5.8%). Only 2 of the 7 patients had early esophageal cancers. Conclusion: The risk of squamous cell neoplasiaof the esophagusis high in patients with head and neck cancer. Surveillance should be strongly recommendedin this high-risk group of patients.
was found in 57 subjects overall (83%) with a mean IM score of 10.3+5.7. Fifty-five subjects were HP seropositive (80%), among whom HP was found on biopsies in 46 with a mean HP score of 9.9+-6. Individuals without IM had a higher PGI/II ratio than those with IM (2.4+_0.5 vs. 1.9-+0.7, p = 0.02). PGI levels were inversely correlated with the degree of IM Subjects with extensive IM (score > 10) had significantly lower HP scores (5.6+-6.4 vs. 9.1 -+7.5, p =0.03). No significant differences in IM or HP scores were found between the different generations of Japanese Americans or in those with a family history of gastric cancer. CONCLUSION:83% of a group of Americans at increasedrisk for gastric cancer whose serum PGI was < 70 p,g/I and PG 1/11ratio -< 3 had gastric IM. Long-term surveillance of this cohort may determine the ultimate benefit of this approach to gastric cancer screening. alT/ Serum Pre-thffemmatoqf ¢ytokleos, Gastrin And Pepsinogensin Screening For
At~
SedV6=t=~
Silvia Sanduleanu, Univ Hosp Maastdcht, Dept of Gastroenterology,Moastricht Netherlands; Adriaan De Sruine, Univ Hosp Maastricht, Dept of Pathology, Maastricht Netherlands; Izak Biemond, Univ Hosp Leiden, Dept of Gastroenterology,Leiden Netherlands; Gudmar Lundqvist, Sept of Medical Science and Clin Chemistry, Uppeala Sweden; Wire Hamaeteman,Univ Hosp Maastricht, Dept of Gastroenterology,Maastricht Netherlands; Cornelius tamers, Univ Hosp Leiden, Sept of Gastroenterology,Leiden Netherlands; Reinhold W. Stockbrugger, Univ Hosp Maestricht, Dept of Gastroenterology, Maastricht Netherlands BACKGROUND:Elevated serum gastrin and a decreased pepsinogen A:C ratio are known predictors of atrophic body gastrt~s. L~e is known about their relation with serum proinflammatory cytokine profile. This study analyzed the diagnostic value of serum gastrin, pepsinegeos,and pro-intbmmstory cytokines in screeningfor atrophic body gastritis. METHODS: 226 consecutivedyspeptic patients referred for upper gastrointestinal endoscopyto an open-access unit were investigated (150 patients with gastro-oesopbegealreflux diseases undergoing treatment with acid inhibitors (proton pump inhibitors [PPIs, n = 113] or histamine2-receptorantagonists [H2RAs, n =37), and 76 subjects without acid inhibition). Gastric mucosel biopsieswere examinedfor classificationof gastritis (Sydneysystem). Serum samples were analyzedfor pastrin and pepsinogeneA, C and A:C ratio (by radioimmunoassay),and for interleukin (IL)-lbeta, IL-6 and IL-8 (by ELISA). RESULTS:In H.pylori-positive subjects, atrophic body oastr~dswas detected in 25% of the controls, 46.7% of patients on H2RAsand 54.7% of patients on PPIs. Among the three groups, subjects with atrophic body gastritis had significantly higher serum gastrin (P
3075 Nigh-risk Population for Stomach Cancer Detected by Serum POllmlloilen and Antibodies to N. pylori Shintaro Kitauchi, Wakayama Medical Univ, Wakayama-CityJapan; Hiroshi Ohata, Akiyoshi Yoshikawa, Osamu Mohara, Masataka Iwane, Koichi Mugitani, WakayamaWellness Fdn, Wakayama-City Japan; Kazuyuki Nakazawa,Kimifiiko Yananka, Hideyuki Tamai, Aldko Shiotani, Masao Ichinose, Wakayama Medical Univ, Wakayama-CifyJapan BACKGROUND:Stomach cancer remains one of the leading causes of cancer-relateddeath worldwide. In Japan, a stomach cancerscreeningprogram using barium X-ray was introduced in 1960s as a public health service and thousands of stomach cancer cases are detected each year. To improve the efficiency of the screening program, it is necessaryto select the high risk population. H. pylori (HP) is considered as a cause of atrophic gastntis together with intestinal metaplasia, which is regarded as the first step of a sequence of mucosal changes in stomach leading to the cancer. Serum pepsinogeo (PC) levels provide a precise measure for the extent of the gastritis. Using the serologic marker, we have done a followup study and haveevaluatedthe risk for stomach cancerassociatedwith HP infection, atrophic gastritis or atrophic gastritis with extensive intestinal metaplasia. METHODS:5480 subjects underwent gastric mass screening during five year pednd of 1996 to 2000. Fasting blood samples were collected for annual routine laboratory tests. Aliquots of the separated sera were stored frozen until measurement. Atrophic gastritis was diagnosed on the basis of the previously described criteria (Jpn J Cancer Clin 38: 221, 1992): PG I level of less than 70 /~g/I and PG 1/11ratio of less than 3.0. Subjects with anti-HP IgG antibody fiter of more than 50U/ml were classified as NP-infected. Thosewith less than 30U/m} were regardedas negative. All subjects were screened annually by barium X-ray. Subjects with positive findings of Xray and/or positive PG test were further examined by panendoscopy.RESULTS: During the five years, 34 cases of stomach cancer developed and 29 cancers were in the early stage (85%). The incidence of stomach cancer increased by HP-infection: from 0% (0/1078) in HP(-)/PG(-) group with HP-free healthy mucosa to 0.5% (16/2822) in HP(+)/PG(-) group with the mucosa where acid-peptic disease is prevalent. Thereafter, the cancer incidence increased in a stepwise-manner with the progression of atrophic gastritis: 1.7% (17/1019) in HP(+)/PG(+) group with extensive atrophic gastritis reaching the highest dsk of 3.7% (1/27) in HP(-)/PG(+) group with extensive intestinal metaplasia,where HP is completely lost from stomach mucosa.CONCLUSION:The results of the presentstudy clearlydemonstrate that with the use of the serologic markers it is possible to reducethe large group of subjects with HP-infection into smaller group with greatercancer risk: a group with extensivemetaplastic gastritis.
3o78 Effect Of Periodic EndoscoPyFor Gastric Cancer On Early Detection And Improving Sunrival Yuji Morii, Takaneri Yoshida, Takashi Matsumata, Nakatsu Municipal Hosp, Oita Japan; Tsuyoshi Arita, Katsuhiro Shimoda, Adta Gastrointestinal Hosp, Oita Japan; Seigo Kitano, Oita Medical Univ, Oita Japan BACKGROUND:The outcomes of surgical treatment for gastric cancer are closely related to the stage of advancement.The use of periodic gastric endoscopy is credited for increasing the early detection and leading to an improved prognosis for patients with gastric cancer. However,whetherannual endoscopicexaminationis necessaryis questionable,and the optimal interval between screenings is unclear. AIM: The aim of this study is to establish the value of and appropriate intervals between periodic gastric endoscopy. METHODS:Of 361 patients underwent surgical treatment for gastric cancer, 106 underwent endoscopic examination within 2 years before detection of gastric cancer (group 1), and 255 underwent examination more than 2 years or no examination (group 2). The clinicopathologic characteristics and outcomes of these two groups were compared. For evaluation of survival rate, the patients in both groups were classified into two sub-groups: group la, endoscopic examinationwithin 1 year before detection; group lb, more than 1 year and within 2 years; group 2a, more than 2 years and within 4 years; and group 2b, more than 4 years or no examination. RESULTS: Gastric cancer in group 1 was characterizedby small tumor size (2.6 _+2.1 crn), superficial type (96%), no tumor invasion beyond the submucosa (92%), few lymphatic (18%) and vascular permeations (16%), and few lymph node metastasis (8%). The cumulative 5-year survival rate for group 1 patients (96.5%) was significantly higher than that for group 2 patients (71.0%, p < 0.01). For the four sub-groups, cumulative 5-year survival rates were 98.2% (group la), 94.2% (group lb), 80.4% (group 2a), and 70.0% (group 2b). The difference betweengroup la and group lb survival rateswas not significant (p = 0.4695). The difference between group la and group 2a survival rates were significant (p < 0.05), although the difference betweengroup lb and 2a survival rates was not significant (p = 0.0533). CONCLUSIONS: Periodic gastric endoscopy enables early detection of cancer, thereby improving survival. The optimal interval for periodic examination is likely to be 2 years.
3076 Gastric Intestinal Metaplasia in Japanese Americans: Correlation with Serum Pepsinogen Levels and Heiicobacter pylori Serology Hubert Nietsch, Cyrus E. Ruble, Univ of Washington, Seattle, WA; Tsukasa Namekata, Pacific Rim Disease Prevention Ctr, Seattle, WA; KazumasaMiki, Toho Univ, Tokyo Japan; Michael B. Kimmey, Univ of Washington, Seattle, WA Serum pepsinogentesting has beenused in Japanto identify individuals with atrophic gastritis for subsequent endoscopic gastric cancer screening. Pepsinogen I (PC I) levels < 70 p,g/I and a ratio of pepsinogeoI to pepsinogen II (PC II) -<3 correlate well with diminished parietal cell mass in this population. The relationship of PG levelsto gastric intestinal metaplasia(IM) and Helicobacter pylori (HP) infection has not been thoroughly studied. The OBJECTIVESof this study were to compare serum pepsinogenlevels and lip serology to histologic evidence of gastric IM and the presence of HP in a cohort of JapaneseAmericans. METHODS:Sera from 776 Seattle residents of Japanese descent were assayedfor levels of papsinogen I and II (radioimmunoassay)and for antibodies to HP (immunosorpeut assay). 69 of 103 subjects with pepsinogen I < 70 p9/I and PG 1/11ratio -< 3 underwent endoscopy.These individuals had a mean age of 65 (range 31 - 81) and were first generation (n = 17), second generation (n = 48) or third generation (n = 4) JapaneseAmericans. Nine biopsies were obtained from each subject: antrum 3; angularis 3; fundus 2; and cardia 1. Degrees of inflammation, IM and HP (Genta stain) were graded from O to 3 in each biopsy and IM and HP scores were calculated for each individual by adding the scores from each of the biopsies. RESULTS:IM
A-606
Background: Due to advanceddiseaseat the time of diagnosis the prognosis of esophageal cancer is generally poor. As mass screening for esophagealcancer is neither feasible nor reasonable, groups of people that are at high risk should be identified and surveiged. The aim of this study was to define the risk of esophagealcancer in patients with (previous) head and neck cancer. Methods: From August 1999 to November2000 120 patientswith (previous) head and neck cancer were prospectively screenedfor esophagealcancer by high-resolution videoesophagoscopy,Even in a macroscopicallynormal appearingesophagus4 biopsy specimen were taken every 3 cm throughout the length of the squamous esophagus in the last 70 of the 120 patients. Results: Low-, moderate- or high-grade squamous cell dysplesiawas detected histologically in 7 of the 70 patients (10.0%). Esophagealsqoamous cell cardnoma was diagnosed in 7 of the 120 patients (5.8%). Only 2 of the 7 patients had early esophageal cancers. Conclusion: The risk of squamous cell neoplasiaof the esophagusis high in patients with head and neck cancer. Surveillance should be strongly recommendedin this high-risk group of patients.
was found in 57 subjects overall (83%) with a mean IM score of 10.3+5.7. Fifty-five subjects were HP seropositive (80%), among whom HP was found on biopsies in 46 with a mean HP score of 9.9+-6. Individuals without IM had a higher PGI/II ratio than those with IM (2.4+_0.5 vs. 1.9-+0.7, p = 0.02). PGI levels were inversely correlated with the degree of IM Subjects with extensive IM (score > 10) had significantly lower HP scores (5.6+-6.4 vs. 9.1 -+7.5, p =0.03). No significant differences in IM or HP scores were found between the different generations of Japanese Americans or in those with a family history of gastric cancer. CONCLUSION:83% of a group of Americans at increasedrisk for gastric cancer whose serum PGI was < 70 p,g/I and PG 1/11ratio -< 3 had gastric IM. Long-term surveillance of this cohort may determine the ultimate benefit of this approach to gastric cancer screening. alT/ Serum Pre-thffemmatoqf ¢ytokleos, Gastrin And Pepsinogensin Screening For
At~
SedV6=t=~
Silvia Sanduleanu, Univ Hosp Maastdcht, Dept of Gastroenterology,Moastricht Netherlands; Adriaan De Sruine, Univ Hosp Maastricht, Dept of Pathology, Maastricht Netherlands; Izak Biemond, Univ Hosp Leiden, Dept of Gastroenterology,Leiden Netherlands; Gudmar Lundqvist, Sept of Medical Science and Clin Chemistry, Uppeala Sweden; Wire Hamaeteman,Univ Hosp Maastricht, Dept of Gastroenterology,Maastricht Netherlands; Cornelius tamers, Univ Hosp Leiden, Sept of Gastroenterology,Leiden Netherlands; Reinhold W. Stockbrugger, Univ Hosp Maestricht, Dept of Gastroenterology, Maastricht Netherlands BACKGROUND:Elevated serum gastrin and a decreased pepsinogen A:C ratio are known predictors of atrophic body gastrt~s. L~e is known about their relation with serum proinflammatory cytokine profile. This study analyzed the diagnostic value of serum gastrin, pepsinegeos,and pro-intbmmstory cytokines in screeningfor atrophic body gastritis. METHODS: 226 consecutivedyspeptic patients referred for upper gastrointestinal endoscopyto an open-access unit were investigated (150 patients with gastro-oesopbegealreflux diseases undergoing treatment with acid inhibitors (proton pump inhibitors [PPIs, n = 113] or histamine2-receptorantagonists [H2RAs, n =37), and 76 subjects without acid inhibition). Gastric mucosel biopsieswere examinedfor classificationof gastritis (Sydneysystem). Serum samples were analyzedfor pastrin and pepsinogeneA, C and A:C ratio (by radioimmunoassay),and for interleukin (IL)-lbeta, IL-6 and IL-8 (by ELISA). RESULTS:In H.pylori-positive subjects, atrophic body oastr~dswas detected in 25% of the controls, 46.7% of patients on H2RAsand 54.7% of patients on PPIs. Among the three groups, subjects with atrophic body gastritis had significantly higher serum gastrin (P
3075 Nigh-risk Population for Stomach Cancer Detected by Serum POllmlloilen and Antibodies to N. pylori Shintaro Kitauchi, Wakayama Medical Univ, Wakayama-CityJapan; Hiroshi Ohata, Akiyoshi Yoshikawa, Osamu Mohara, Masataka Iwane, Koichi Mugitani, WakayamaWellness Fdn, Wakayama-City Japan; Kazuyuki Nakazawa,Kimifiiko Yananka, Hideyuki Tamai, Aldko Shiotani, Masao Ichinose, Wakayama Medical Univ, Wakayama-CifyJapan BACKGROUND:Stomach cancer remains one of the leading causes of cancer-relateddeath worldwide. In Japan, a stomach cancerscreeningprogram using barium X-ray was introduced in 1960s as a public health service and thousands of stomach cancer cases are detected each year. To improve the efficiency of the screening program, it is necessaryto select the high risk population. H. pylori (HP) is considered as a cause of atrophic gastntis together with intestinal metaplasia, which is regarded as the first step of a sequence of mucosal changes in stomach leading to the cancer. Serum pepsinogeo (PC) levels provide a precise measure for the extent of the gastritis. Using the serologic marker, we have done a followup study and haveevaluatedthe risk for stomach cancerassociatedwith HP infection, atrophic gastritis or atrophic gastritis with extensive intestinal metaplasia. METHODS:5480 subjects underwent gastric mass screening during five year pednd of 1996 to 2000. Fasting blood samples were collected for annual routine laboratory tests. Aliquots of the separated sera were stored frozen until measurement. Atrophic gastritis was diagnosed on the basis of the previously described criteria (Jpn J Cancer Clin 38: 221, 1992): PG I level of less than 70 /~g/I and PG 1/11ratio of less than 3.0. Subjects with anti-HP IgG antibody fiter of more than 50U/ml were classified as NP-infected. Thosewith less than 30U/m} were regardedas negative. All subjects were screened annually by barium X-ray. Subjects with positive findings of Xray and/or positive PG test were further examined by panendoscopy.RESULTS: During the five years, 34 cases of stomach cancer developed and 29 cancers were in the early stage (85%). The incidence of stomach cancer increased by HP-infection: from 0% (0/1078) in HP(-)/PG(-) group with HP-free healthy mucosa to 0.5% (16/2822) in HP(+)/PG(-) group with the mucosa where acid-peptic disease is prevalent. Thereafter, the cancer incidence increased in a stepwise-manner with the progression of atrophic gastritis: 1.7% (17/1019) in HP(+)/PG(+) group with extensive atrophic gastritis reaching the highest dsk of 3.7% (1/27) in HP(-)/PG(+) group with extensive intestinal metaplasia,where HP is completely lost from stomach mucosa.CONCLUSION:The results of the presentstudy clearlydemonstrate that with the use of the serologic markers it is possible to reducethe large group of subjects with HP-infection into smaller group with greatercancer risk: a group with extensivemetaplastic gastritis.
3o78 Effect Of Periodic EndoscoPyFor Gastric Cancer On Early Detection And Improving Sunrival Yuji Morii, Takaneri Yoshida, Takashi Matsumata, Nakatsu Municipal Hosp, Oita Japan; Tsuyoshi Arita, Katsuhiro Shimoda, Adta Gastrointestinal Hosp, Oita Japan; Seigo Kitano, Oita Medical Univ, Oita Japan BACKGROUND:The outcomes of surgical treatment for gastric cancer are closely related to the stage of advancement.The use of periodic gastric endoscopy is credited for increasing the early detection and leading to an improved prognosis for patients with gastric cancer. However,whetherannual endoscopicexaminationis necessaryis questionable,and the optimal interval between screenings is unclear. AIM: The aim of this study is to establish the value of and appropriate intervals between periodic gastric endoscopy. METHODS:Of 361 patients underwent surgical treatment for gastric cancer, 106 underwent endoscopic examination within 2 years before detection of gastric cancer (group 1), and 255 underwent examination more than 2 years or no examination (group 2). The clinicopathologic characteristics and outcomes of these two groups were compared. For evaluation of survival rate, the patients in both groups were classified into two sub-groups: group la, endoscopic examinationwithin 1 year before detection; group lb, more than 1 year and within 2 years; group 2a, more than 2 years and within 4 years; and group 2b, more than 4 years or no examination. RESULTS: Gastric cancer in group 1 was characterizedby small tumor size (2.6 _+2.1 crn), superficial type (96%), no tumor invasion beyond the submucosa (92%), few lymphatic (18%) and vascular permeations (16%), and few lymph node metastasis (8%). The cumulative 5-year survival rate for group 1 patients (96.5%) was significantly higher than that for group 2 patients (71.0%, p < 0.01). For the four sub-groups, cumulative 5-year survival rates were 98.2% (group la), 94.2% (group lb), 80.4% (group 2a), and 70.0% (group 2b). The difference betweengroup la and group lb survival rateswas not significant (p = 0.4695). The difference between group la and group 2a survival rates were significant (p < 0.05), although the difference betweengroup lb and 2a survival rates was not significant (p = 0.0533). CONCLUSIONS: Periodic gastric endoscopy enables early detection of cancer, thereby improving survival. The optimal interval for periodic examination is likely to be 2 years.
3076 Gastric Intestinal Metaplasia in Japanese Americans: Correlation with Serum Pepsinogen Levels and Heiicobacter pylori Serology Hubert Nietsch, Cyrus E. Ruble, Univ of Washington, Seattle, WA; Tsukasa Namekata, Pacific Rim Disease Prevention Ctr, Seattle, WA; KazumasaMiki, Toho Univ, Tokyo Japan; Michael B. Kimmey, Univ of Washington, Seattle, WA Serum pepsinogentesting has beenused in Japanto identify individuals with atrophic gastritis for subsequent endoscopic gastric cancer screening. Pepsinogen I (PC I) levels < 70 p,g/I and a ratio of pepsinogeoI to pepsinogen II (PC II) -<3 correlate well with diminished parietal cell mass in this population. The relationship of PG levelsto gastric intestinal metaplasia(IM) and Helicobacter pylori (HP) infection has not been thoroughly studied. The OBJECTIVESof this study were to compare serum pepsinogenlevels and lip serology to histologic evidence of gastric IM and the presence of HP in a cohort of JapaneseAmericans. METHODS:Sera from 776 Seattle residents of Japanese descent were assayedfor levels of papsinogen I and II (radioimmunoassay)and for antibodies to HP (immunosorpeut assay). 69 of 103 subjects with pepsinogen I < 70 p9/I and PG 1/11ratio -< 3 underwent endoscopy.These individuals had a mean age of 65 (range 31 - 81) and were first generation (n = 17), second generation (n = 48) or third generation (n = 4) JapaneseAmericans. Nine biopsies were obtained from each subject: antrum 3; angularis 3; fundus 2; and cardia 1. Degrees of inflammation, IM and HP (Genta stain) were graded from O to 3 in each biopsy and IM and HP scores were calculated for each individual by adding the scores from each of the biopsies. RESULTS:IM
A-606