No support for endoscopic surveillance for gastric cancer in hereditary non-polyposis colorectal cancer.
BACKGROUND
The DNA mismatch repair gene mutations underlying hereditary non-polyposis colorectal cancer syndrome (HNPCC) also predispose, besides colorectal and endometrial cancer, to gastric cancer. usually of the intestinal type. The carcinogenetic pathway behind the elevated gastric cancer risk is largely unknown.


METHODS
The aim of this study was to determine whether there are any premalignant lesions to search for in gastric surveillance in HNPCC by comparing gastric histopathology between mutation-positive and mutation-negative family members. We searched for differences in occurrence of Helicobacter pylori, inflammation, atrophy, intestinal metaplasia and dysplastic changes. Upper gastrointestinal endoscopy was performed for 73 mutation-positive and 32 mutation-negative family members.


RESULTS
One case of duodenal cancer was detected in the mutation-positive group, but no gastric neoplastic lesions were seen in either group. There were no differences in the occurrence of polyps, H. pylori, inflammation, activity, atrophy nor intestinal metaplasia tested with binaric, logistic, regression analysis.


CONCLUSIONS
We conclude that surveillance gastroscopy may not be beneficial in HNPCC, since neither cases of early cancer nor premalignant lesions could be detected in our series of 73 mutation-positive subjects.
Renkonen-Sinisalo
L
L
Dept of Surgery, Helsinki University Hospital, Finland.
Sipponen
P
P
Aarnio
M
M
Julkunen
R
R
Aaltonen
L A
LA
Sarna
S
S
Järvinen
H J
HJ
Mecklin
J P
JP
D000328:Adult; D000367:Age Factors; D000368:Aged; D020137:Base Pair Mismatch / Q000235:genetics; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000150:complications / Q000453:epidemiology* / Q000235:genetics; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005756:Gastritis / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000150:complications / Q000453:epidemiology* / Q000235:genetics; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000235:genetics