Background and aim: Helicobacter pylori infection and gastric atrophy are both risk factors for gastric cancer. We aimed to elucidate the natural history of gastric cancer development according to H pylori infection a...Background and aim: Helicobacter pylori infection and gastric atrophy are both risk factors for gastric cancer. We aimed to elucidate the natural history of gastric cancer development according to H pylori infection and gastric atrophy status. Subjects and methods: A total of 9293 participants in a mass health appraisal programme were candidates for inclusion in the present prospective cohort study: 6983 subjects revisited the follow up programme. Subjects were classified into four groups according to serological status at initial endoscopy. Group A (n = 3324) had “normal”pepsinogen and were negative for H pylori antibody; group B (n = 2134) had “normal”pepsinogen and were positive for H pylori antibody; group C (n = 1082) had “atrophic”pepsinogen and were positive for H pylori antbody; and group D (n = 443) had “atrophic”pepsinogen and were negative for Hpylori antibody. Incidence of gastric cancer was determined by annual endoscopic examination. Results: Mean duration of follow up was 4.7 years and the average number of endoscopic examinations was 5.1. The annual incidence of gastric cancer was 0.04%(95%confidence interval (CI) 0.02-0.09), 0.06%(0.03-0.13), 0.35%(0.23-0.57), and 0.60%(0.34-1.05) in groups A, B, C, and D, respectively. Hazard ratios compared with group A were 1.1 (95%CI 0.4-3.4), 6.0 (2.4-14.5), and 8.2 (3.2-21.5) in groups B, C, and D, respectively. Age, sex, and “group”significantly served as independent valuables by multivariate analysis. Conclusions: The combination of serum pepsinogen and anti-H pylori antibody provides a good predictive marker for the development of gastric cancer.展开更多
Background & Aims: The fecal occult blood test (FOBT) is recommended as a screening test for colorectal cancer, but there are few reliable studies on the accuracy of immunochemical FOBT. The aim of this study was ...Background & Aims: The fecal occult blood test (FOBT) is recommended as a screening test for colorectal cancer, but there are few reliable studies on the accuracy of immunochemical FOBT. The aim of this study was to analyze the sensitivity of immunochemical FOBT and to compare the results with the findings from complete colonoscopy. Methods: Asymptomatic adults underwent 1-time immunochemical FOBT and total colonoscopy simultaneously. The prevalence and location of colorectal neoplasia were determined by colonoscopy. The results of immunochemical FOBT and the colonoscopic findings were compared. Results: Of 21,805 patients, immunochemical FOBT was positive in 1231 cases (5.6% ). The sensitivity of 1-time immunochemical FOBT for detecting advanced neoplasia and invasive cancer was 27.1% and 65.8% , respectively. In addition, the sensitivity for invasive cancer according to Dukes’ stage showed 50.0% for Dukes’ stage A, 70.0% for Dukes’ stage B, and 78.3% for Dukes’ stages C or D. The sensitivity for detecting advanced neoplasia at the proximal colon was significantly lower than that detected in the distal colon (16.3% vs 30.7% , P = .00007). Conclusions: Although the screening of asymptomatic patients with immunochemical FOBT can identify patients with colorectal neoplasia to a certain extent, the sensitivity is relatively low and different according to the tumor location. Therefore, programmatic and repeated screening by immunochemical FOBT may be necessary to increase sensitivity for colorectal cancer detection.展开更多
BACKGROUND: Flat-type colorectal cancer is frequently reported in Japan and Europe, but its clinical features remain obscure. Thus, we investigated the clinical features of flat-type early colorectal cancer with respe...BACKGROUND: Flat-type colorectal cancer is frequently reported in Japan and Europe, but its clinical features remain obscure. Thus, we investigated the clinical features of flat-type early colorectal cancer with respect to tumor location and patient age and compared them with those of polypoid-type early and advanced cancer. METHODS: Between January 1999 and June 2001, total colonoscopy was performed in 6,178 patients (mean age, 61 years; 4,290 males and 1,888 females). Of these patients, 402 patients with 429 colorectal cancers were found: 202 at advanced stage (invading beyond muscularis propria) and 227 at early stage (carcinoma in situ or invading within submucosa). Early-stage cancer was classified into two macroscopic subgroups: flat-type and polypoid-type. RESULTS: Out of 227 early cancers, 44 were flat type and 183 were polypoid. Flat-type early cancer was more frequently located in the right colon (57 percent, 25/44) than polypoid-type cancer (19 percent, 35/183; P < 0.001). Adenomatous component in flat-type early cancer was less frequent than in polypoid-type cancer (23 percent vs. 92 percent, P < 0.001). The proportion of right-sided colon in flat-type early cancer increased with age (33 percent in patients ≤59 years, 50 percent in patients between 60 and 69 years, and 72 percent in patients ≥70 years), whereas polypoid-type early cancer showed minimal change (16 percent, 18 percent, and 25 percent, respectively). An increase in the proportion of right-sided colon with age was also found in advanced cancer (20 percent, 38 percent, and 52 percent, respectively). CONCLUSION: The incidence of flat-type early cancer in right-sided colon increased with age, similar to the pattern of advanced cancer. This suggests that flat-type early cancer may be a precursor of advanced cancer in the right colon, especially in older people.展开更多
Background: Although it is known that right-side colon cancers increase with aging, the location of adenomas according to age has been controversial. Adenomas found at initial colonoscopies may be a mixture of polyps ...Background: Although it is known that right-side colon cancers increase with aging, the location of adenomas according to age has been controversial. Adenomas found at initial colonoscopies may be a mixture of polyps that arose at various earlier ages. Objectives: To elucidate the relationship between location and age at which adenomas actually developed. Design: Prospective cohort study. A large-scale health appraisal institution in Japan. Patients: A total of 23,444 consecutive, asymptomatic Japanese who underwent total colonoscopy at their annual medical health check-up. Interventions: We analyzed newly developed adenomas after confirmation of the Absence of colorectal neoplasms by two serial total colonoscopies. Main Outcome Measurements: The results of follow-up colonoscopies in 6304 subjects with no colorectal neoplasms at 2 initial colonoscopies were analyzed. The locations were separated into right-side colon and left-side colon from the splenic flexure. The locations of new adenomas found for the first time during the follow-up term were analyzed. Results: A total of 1472 subjects developed new colorectal adenomas. In 1255 cases with single adenomas, the ratios of number of cases with right-side lesions to that with left-side lesions at the ages of < 40 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, and ≥ 70 years were 1.18, 1.00, 1.29, 1.31, and 1.89, respectively. In 217 cases with multiple adenomas found concurrently, the percentage of cases with adenomas only on the right side at the ages of < 40 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, and ≥ 70 years were 0% , 25% , 34% , 37% , and 63% , respectively. Limitations: Small lesions might have been missed even by 2 serial colonoscopies. Conclusions: Adenomas on the right-side colon increased with aging.展开更多
文摘Background and aim: Helicobacter pylori infection and gastric atrophy are both risk factors for gastric cancer. We aimed to elucidate the natural history of gastric cancer development according to H pylori infection and gastric atrophy status. Subjects and methods: A total of 9293 participants in a mass health appraisal programme were candidates for inclusion in the present prospective cohort study: 6983 subjects revisited the follow up programme. Subjects were classified into four groups according to serological status at initial endoscopy. Group A (n = 3324) had “normal”pepsinogen and were negative for H pylori antibody; group B (n = 2134) had “normal”pepsinogen and were positive for H pylori antibody; group C (n = 1082) had “atrophic”pepsinogen and were positive for H pylori antbody; and group D (n = 443) had “atrophic”pepsinogen and were negative for Hpylori antibody. Incidence of gastric cancer was determined by annual endoscopic examination. Results: Mean duration of follow up was 4.7 years and the average number of endoscopic examinations was 5.1. The annual incidence of gastric cancer was 0.04%(95%confidence interval (CI) 0.02-0.09), 0.06%(0.03-0.13), 0.35%(0.23-0.57), and 0.60%(0.34-1.05) in groups A, B, C, and D, respectively. Hazard ratios compared with group A were 1.1 (95%CI 0.4-3.4), 6.0 (2.4-14.5), and 8.2 (3.2-21.5) in groups B, C, and D, respectively. Age, sex, and “group”significantly served as independent valuables by multivariate analysis. Conclusions: The combination of serum pepsinogen and anti-H pylori antibody provides a good predictive marker for the development of gastric cancer.
文摘Background & Aims: The fecal occult blood test (FOBT) is recommended as a screening test for colorectal cancer, but there are few reliable studies on the accuracy of immunochemical FOBT. The aim of this study was to analyze the sensitivity of immunochemical FOBT and to compare the results with the findings from complete colonoscopy. Methods: Asymptomatic adults underwent 1-time immunochemical FOBT and total colonoscopy simultaneously. The prevalence and location of colorectal neoplasia were determined by colonoscopy. The results of immunochemical FOBT and the colonoscopic findings were compared. Results: Of 21,805 patients, immunochemical FOBT was positive in 1231 cases (5.6% ). The sensitivity of 1-time immunochemical FOBT for detecting advanced neoplasia and invasive cancer was 27.1% and 65.8% , respectively. In addition, the sensitivity for invasive cancer according to Dukes’ stage showed 50.0% for Dukes’ stage A, 70.0% for Dukes’ stage B, and 78.3% for Dukes’ stages C or D. The sensitivity for detecting advanced neoplasia at the proximal colon was significantly lower than that detected in the distal colon (16.3% vs 30.7% , P = .00007). Conclusions: Although the screening of asymptomatic patients with immunochemical FOBT can identify patients with colorectal neoplasia to a certain extent, the sensitivity is relatively low and different according to the tumor location. Therefore, programmatic and repeated screening by immunochemical FOBT may be necessary to increase sensitivity for colorectal cancer detection.
文摘BACKGROUND: Flat-type colorectal cancer is frequently reported in Japan and Europe, but its clinical features remain obscure. Thus, we investigated the clinical features of flat-type early colorectal cancer with respect to tumor location and patient age and compared them with those of polypoid-type early and advanced cancer. METHODS: Between January 1999 and June 2001, total colonoscopy was performed in 6,178 patients (mean age, 61 years; 4,290 males and 1,888 females). Of these patients, 402 patients with 429 colorectal cancers were found: 202 at advanced stage (invading beyond muscularis propria) and 227 at early stage (carcinoma in situ or invading within submucosa). Early-stage cancer was classified into two macroscopic subgroups: flat-type and polypoid-type. RESULTS: Out of 227 early cancers, 44 were flat type and 183 were polypoid. Flat-type early cancer was more frequently located in the right colon (57 percent, 25/44) than polypoid-type cancer (19 percent, 35/183; P < 0.001). Adenomatous component in flat-type early cancer was less frequent than in polypoid-type cancer (23 percent vs. 92 percent, P < 0.001). The proportion of right-sided colon in flat-type early cancer increased with age (33 percent in patients ≤59 years, 50 percent in patients between 60 and 69 years, and 72 percent in patients ≥70 years), whereas polypoid-type early cancer showed minimal change (16 percent, 18 percent, and 25 percent, respectively). An increase in the proportion of right-sided colon with age was also found in advanced cancer (20 percent, 38 percent, and 52 percent, respectively). CONCLUSION: The incidence of flat-type early cancer in right-sided colon increased with age, similar to the pattern of advanced cancer. This suggests that flat-type early cancer may be a precursor of advanced cancer in the right colon, especially in older people.
文摘Background: Although it is known that right-side colon cancers increase with aging, the location of adenomas according to age has been controversial. Adenomas found at initial colonoscopies may be a mixture of polyps that arose at various earlier ages. Objectives: To elucidate the relationship between location and age at which adenomas actually developed. Design: Prospective cohort study. A large-scale health appraisal institution in Japan. Patients: A total of 23,444 consecutive, asymptomatic Japanese who underwent total colonoscopy at their annual medical health check-up. Interventions: We analyzed newly developed adenomas after confirmation of the Absence of colorectal neoplasms by two serial total colonoscopies. Main Outcome Measurements: The results of follow-up colonoscopies in 6304 subjects with no colorectal neoplasms at 2 initial colonoscopies were analyzed. The locations were separated into right-side colon and left-side colon from the splenic flexure. The locations of new adenomas found for the first time during the follow-up term were analyzed. Results: A total of 1472 subjects developed new colorectal adenomas. In 1255 cases with single adenomas, the ratios of number of cases with right-side lesions to that with left-side lesions at the ages of < 40 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, and ≥ 70 years were 1.18, 1.00, 1.29, 1.31, and 1.89, respectively. In 217 cases with multiple adenomas found concurrently, the percentage of cases with adenomas only on the right side at the ages of < 40 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, and ≥ 70 years were 0% , 25% , 34% , 37% , and 63% , respectively. Limitations: Small lesions might have been missed even by 2 serial colonoscopies. Conclusions: Adenomas on the right-side colon increased with aging.
