Surveillance of premalignant gastric cardia lesions: A population-based prospective cohort study in China

Jianhua Gu, Shuanghua Xie, Shaoming Wang*, Liyan Xue, Jiachen Zhou, Minjuan Li, Zhiyuan Fan, Ru Chen, Daniel R.S. Middleton, Changqing Hao, Jinwu Wang, Bianyun Li, Xinqing Li, Wenqiang Wei

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


In our study, we aimed to assess the long-term risk of gastric cardia adenocarcinoma (GCA) for patients with different histological cardia lesions to inform future guidelines for GCA screening in China. We conducted a population-based prospective study among 9740 subjects who underwent upper endoscopy screening during 2005 to 2009 and followed until December 2017. Cumulative incidence and mortality rates of GCA were calculated by the baseline histological diagnoses, and the hazard ratios (HRs), overall and by age and sex, were analyzed by Cox proportional hazards models. During a median follow-up of 10 years, we identified 123 new GCA cases (1.26%) and 31 GCA deaths (0.32%). The age-standardized incidence and mortality rates of GCA were 128.71/100 000 and 35.69/100 000 person-years, and cumulative incidence rate in patients with cardia high-grade dysplasia (CHGD), cardia low-grade dysplasia (CLGD) and atrophic carditis (AC)/cardia intestinal metaplasia (CIM) was 25%, 3.05% and 1.58%, respectively. The progression rate and cancer risk of GCA increased monotonically with each step in Correa's cascade. Individuals aged 50 to 69 years had 4.4 times higher GCA incidence than those aged 40 to 49 years. Patients with CLGD had a significantly higher 3-year GCA incidence than the normal group, while patients with AC/CIM had a comparable GCA risk during 3-year follow-up but a higher risk at 5-year intervals. Our results suggested a postponed starting age of 50 years for GCA screening, immediate treatment for patients with CHGD, a 3-year surveillance interval for patients with CLGD, and a lengthened surveillance interval of 5 years for patients with AC/CIM.

Original languageEnglish
Pages (from-to)1639-1648
Number of pages10
JournalInternational Journal of Cancer
Issue number9
Early online date07 Jul 2021
Publication statusPublished - 01 Nov 2021
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by grants from the Beijing Nova Program (No. Z201100006820069), National Key R&D Program of China (grant number: 2016YFC0901400, 2016YFC0901404), the National Natural Science Fund (grant number: 81974493, 81874277) and the CAMS Innovation Fund for Medical Sciences (grant number: 2019‐I2M‐2‐004, 2018‐I2M‐3‐003).

Funding Information:
Beijing Nova Program, Grant/Award Number: Z201100006820069; CAMS Innovation Fund for Medical Sciences, Grant/Award Numbers: 2019‐I2M‐2‐004, 2018‐I2M‐3‐003; National Key R&D Program of China, Grant/Award Numbers: 2016YFC0901400, 2016YFC0901404; National Natural Science Foundation of China, Grant/Award Number: 81573224; National Natural Science Fund, Grant/Award Numbers: 81874277, 81974493 Funding information

Publisher Copyright:
© 2021 UICC.


  • gastric cardia adenocarcinoma
  • population-based prospective study
  • precursor lesions
  • progression rate

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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