title: Incomplete type of intestinal metaplasia has the highest risk to progress to gastric cancer: results of the Spanish follow-up multicenter study.
abstract: OBJECTIVE
  In high or moderate risk populations, periodic surveillance of patients at risk of progression from gastric precursor lesions (PL) to gastric cancer (GC) is the most effective strategy for reducing the burden of GC. Incomplete type of intestinal metaplasia (IIM) may be considered as the best candidate, but it is still controversial and more research is needed. To further assess the progression of subtypes of IM as predictors of GC occurrence.
  
  
  METHODS
  A follow-up study was carried-out including 649 patients, diagnosed with PL between 1995-2004 in 9 participating hospitals from Spain, and who repeated the biopsy during 2011-2013. Medical information and habits were collected through a questionnaire. Based on morphology, IM was sub-classified as complete (small intestinal type, CIM) and incomplete (colonic type, IIM). Analyses were done using Cox (HR) models.
  
  
  RESULTS
  At baseline, 24% of patients had atrophic gastritis, 38% CIM, 34% IIM, and 4% dysplasia. Mean follow-up was 12 years. 24 patients (3.7%) developed a gastric adenocarcinoma during follow-up. The incidence rate of GC was 2.76 and 5.76 per 1,000 person-years for those with CIM and IIM, respectively. The HR of progression to CG was 2.75 (95% CI 1.06-6.26) for those with IIM compared with those with CIM at baseline, after adjusting for sex, age, smoking, family history of GC and use of NSAIDs.
  
  
  CONCLUSIONS
  IIM is the PL with highest risk to progress to GC. Sub-typing of IM is a valid procedure for the identification of high risk patients that require more intensive surveillance.
authors.affiliation: Unit of Nutrition, Environment and Cancer, Institut Català d'Oncología, Barcelona, Spain.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: González
authors.affiliation: University of Alcalá (Department of Medicine and Medical Especialties), Department of Pathology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Sanz-Anquela
authors.affiliation: Unit of Nutrition, Environment and Cancer, Institut Català d'Oncología, Barcelona, Spain.
authors.forename: Osmel
authors.initials: O
authors.lastname: Companioni
authors.affiliation: Unit of Nutrition, Environment and Cancer, Institut Català d'Oncología, Barcelona, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Bonet
authors.affiliation: Cancer Epigenetics and Biology Program, IDIBELL, Barcelona.
authors.forename: María
authors.initials: M
authors.lastname: Berdasco
authors.affiliation: Department of Pathology, Hospital Universitario de la Princesa, IIS-IP, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid.
authors.forename: Consuelo
authors.initials: C
authors.lastname: López
authors.affiliation: Department of Gastroenterology, Hospital Universitario de la Princesa, IIS-IP, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid.
authors.forename: Jorge
authors.initials: J
authors.lastname: Mendoza
authors.affiliation: Department of Gastroenterology, Hospital Universitario La Paz, Madrid.
authors.forename: M Dolores
authors.initials: MD
authors.lastname: Martín-Arranz
authors.affiliation: Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Rey
authors.affiliation: Department of Gastroenterology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares.
authors.forename: Elvira
authors.initials: E
authors.lastname: Poves
authors.affiliation: Department of Gastroenterology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares.
authors.forename: Laura
authors.initials: L
authors.lastname: Espinosa
authors.affiliation: Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Barrio
authors.affiliation: Department of Pathology, Hospital Universitario Río Hortega, Valladolid, Spain.
authors.forename: M Ángeles
authors.initials: MÁ
authors.lastname: Torres
authors.affiliation: Department of Pathology, Hospital Clínic de Barcelona, IDIBAPS and CIBEREHD, and Universitat de Barcelona, Spain.
authors.forename: Miriam
authors.initials: M
authors.lastname: Cuatrecasas
authors.affiliation: Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS and CIBEREHD, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Elizalde
authors.affiliation: Department of Pathology, and Department of Gastroenterology. Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU). CIBEREHD, San Sebastián, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Bujanda
authors.affiliation: Department of Pathology, and Department of Gastroenterology. Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU). CIBEREHD, San Sebastián, Spain.
authors.forename: Maddi
authors.initials: M
authors.lastname: Garmendia
authors.affiliation: Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Ferrández
authors.affiliation: Department of Pathology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, and CIBEREHD, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Muñoz
authors.affiliation: Department of Gastroenterology, Hospital de Viladecans, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Andreu
authors.affiliation: Department of Pathology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
authors.forename: M Jose
authors.initials: MJ
authors.lastname: Paules
authors.affiliation: Departament of Medicine, Digestive Diseases Service, Institut Universitari Parc Taulí, Sabadell, and CIBEREHD, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Lario
authors.affiliation: Departament of Medicine, Digestive Diseases Service, Institut Universitari Parc Taulí, Sabadell, and CIBEREHD, Spain.
authors.forename: M Jose
authors.initials: MJ
authors.lastname: Ramírez
authors.affiliation: Department of Gastroenterology, Hospital Universitario de la Princesa, IIS-IP, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid.
authors.forename: Javier P
authors.identifier: http://orcid.org/0000-0003-2090-3445
authors.initials: JP
authors.lastname: Gisbert
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology*; D000328:Adult; D001706:Biopsy; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005757:Gastritis, Atrophic / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D015999:Multivariate Analysis; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000473:pathology*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: follow-up study; gastric cancer risk; intestinal metaplasia