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Prior gastroscopy and mortality in patients with gastric cancer: a matched retrospective cohort study

  • Wai K. Leung
    Affiliations
    Department of Medicine, University of Hong Kong, Hong Kong, China
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  • Hsiu J. Ho
    Affiliations
    Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
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  • Jaw-Town Lin
    Affiliations
    School of Medicine, Fu Jen Catholic University, Taipei, Taiwan

    Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
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  • Ming-Shiang Wu
    Affiliations
    Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan
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  • Chun-Ying Wu
    Correspondence
    Reprint requests: Professor Chun-Ying Wu, MD, PhD, MPH, Division of Gastroenterology, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Avenue, Taichung 407, Taiwan.
    Affiliations
    Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan

    Faculty of Medicine and Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Department of Public Health and Graduate Institute of Clinical Medical Sciences, China Medical University, Taichung, Taiwan

    National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan

    Department of Life Sciences and Rong Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan
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      Background and Aims

      The role of prior gastroscopy on the outcome of patients with gastric cancer remains unknown. This study determines the association between intervals of prior gastroscopy and mortality in patients with gastric cancer.

      Methods

      We identified 20,066 newly diagnosed patients with gastric cancer in the National Health Insurance Database of Taiwan between 2002 and 2007. After we excluded patients who had gastroscopies performed ≤6 months before the diagnosis of cancer, patients were matched into 3 cohorts according to the intervals of prior gastroscopy: 6 months to 2 years (<2 Y cohort), 2 to 5 years (2-5 Y cohort), and none within the previous 5 years (>5 Y cohort). The 3 cohorts were matched for age, curative treatment for gastric cancer, Helicobacter pylori therapy, and propensity scores comprised of sex, comorbidities, and concomitant medication usage. The primary outcome is the hazard ratio (HR) of all-cause mortality.

      Results

      After matching, we identified 1286, 1286, and 5144 patients for the <2 Y, 2 to 5 Y, and >5 Y cohorts. Compared with the >5 Y cohort, the HR of all-cause mortality for the <2 Y and 2 to 5 Y cohorts was 0.80 (95% confidence interval [CI], 0.72-0.89; P < .001) and 0.83 (95% CI, 0.76-0.91; P < .001), respectively. The HRs of gastric cancer-specific mortality were significantly lower in the <2 Y (0.80; 95% CI, 0.71-0.91; P < .001) and 2 to 5 Y cohorts (0.83; 95% CI, 0.75-0.93; P < .001).

      Conclusions

      Patients with gastric cancer who had a gastroscopy performed within 5 years before the cancer diagnosis had significantly lower mortality. Our results may support the role of repeat endoscopic examination or surveillance endoscopy in selected patients.

      Abbreviations:

      HP (Helicobacter pylori), HR (hazard ratio), NHIRD (National Health Insurance Research Database), RCIPD (Registry for Catastrophic Illness Patient Database)
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