title: Risk factors and clinical outcomes of gastric cancer identified by screening endoscopy: a case-control study.
abstract: OBJECTIVE
  A customized screening program for gastric cancer would optimize the benefits of screening endoscopy. This study investigated the risk factors for gastric cancer detected during screening and factors affecting clinical outcomes.
  
  
  METHODS
  From April 2000 to December 2010, subjects who underwent screening endoscopy at Asan Medical Center were included. To investigate risk factors, age- and sex-matched control group was selected. The clinical outcomes of gastric cancer identified during screening (screening group) were compared with age, sex, and date of diagnosis-matched subjects who were diagnosed with gastric cancer in the outpatient clinic (outpatient group).
  
  
  RESULTS
  Of 109 530 subjects, 327 were diagnosed with gastric cancer. The median age of the screening group was 63.6 years (interquartile range 56-71 years), and the male-to-female ratio was 2.4:1. When comparing with the control group, Helicobacter pylori seropositivity (odds ratio [OR] 2.933, P < 0.001), carcinoembryonic antigen (OR 8.633, P = 0.004), family history of gastric cancer (OR 2.254, P = 0.007), and drinking (OR 3.312, P < 0.001) were independent positive risk factors, and the use of aspirin a negative risk factor for gastric cancer (OR 0.445, P = 0.012) in multivariate analysis. Low-density lipoprotein cholesterol (hazard ratio [HR] 0.987, P = 0.005), cancer antigen 19-9 (HR 21.713, P < 0.001), resectability (HR 59.833, P < 0.001), and family history (HR 0.308, P = 0.009) were independent risk factors for death. The 5-year survival rate was significantly higher in the screening group than in the outpatient group (P < 0.001).
  
  
  CONCLUSIONS
  Early detection of gastric cancer by screening endoscopy while asymptomatic enhances patient outcomes, especially in high-risk groups.
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Eun Jeong
authors.initials: EJ
authors.lastname: Gong
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Ahn
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
authors.forename: Hyun
authors.initials: H
authors.lastname: Lim
authors.forename: Kwi-Sook
authors.initials: KS
authors.lastname: Choi
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Kim
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.forename: Ho June
authors.initials: HJ
authors.lastname: Song
authors.forename: Gin Hyug
authors.initials: GH
authors.lastname: Lee
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
authors.forename: Son Yeong
authors.initials: SY
authors.lastname: Choi
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Choe
authors.forename: Min-Ju
authors.initials: MJ
authors.lastname: Kim
mesh_terms: D000367:Age Factors; D000368:Aged; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D016022:Case-Control Studies; D008078:Cholesterol, LDL; D004326:Drinking; D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D008078:Cholesterol, LDL
keywords: cancer screening; endoscopy; risk factors; stomach neoplasms