Risk for gastric cancer in patients with gastric atrophy: a systematic review and meta-analysis

Background: The risk for gastric cancer among patients with gastric atrophy is unclear. We investigated the association between the risk for gastric cancer and gastric atrophy. Methods: We performed a comprehensive literature search in the PubMed and Embase databases and extracted relevant data from eligible studies. A fixed- or random-effects model was applied to pool study-specific risk according to heterogeneity across studies. Results: Thirteen cohort or nested case-control studies with 655,937 participants and 2,794 patients with gastric cancer were analyzed. The pooled results suggested that gastric atrophy was associated with an elevated risk for gastric cancer [pooled risk ratio (RR) =2.91, 95% confidence interval (CI): 2.58-3.27]. The pooled RR (3.10, 95% CI: 2.58-3.73) of studies that used serum levels of pepsinogenfor diagnosis of gastric atrophy was similar to that of those that used (pooled RR =2.79, 95% CI: 2.37-3.27) (for endoscopy). Gastric atrophy was positively associated with the risk for gastric cancer in both prospective and retrospective studies. Moreover, the pooled RRs did not significantly vary by country of origin (Asia and Europe) or gastric cancer subtype (cardia and non-cardia). Conclusions: Gastric atrophy is associated with an elevated risk for gastric cancer, and endoscopy and serum levels of pepsinogens can be used to predict the risk.