SSAT - INCIDENCE AND RISK OF NEUROENDOCRINE TUMORS (NET) AND ADENOCARCINOMA IN PATIENTS WITH ATROPHIC GASTRITIS/PERNICIOUS ANEMIA

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INCIDENCE AND RISK OF NEUROENDOCRINE TUMORS (NET) AND ADENOCARCINOMA IN PATIENTS WITH ATROPHIC GASTRITIS/PERNICIOUS ANEMIA
Rachel V. Christenson^*¹, Hala Muaddi¹, Emily Siegler¹, Austin Teel¹, Roma Sonik¹, Nabil Wasif², Thorvardur R. Halfdanarson¹, Katherine Poruk³, Daniel Schupack¹, Derek Ebner¹, Travis E. Grotz¹
¹General Surgery, Mayo Clinic Minnesota, Rochester, MN; ²Mayo Clinic Arizona, Scottsdale, AZ; ³Mayo Clinic in Florida, Jacksonville, FL

Background:
Atrophic gastritis (AG) and pernicious anemia are chronic gastric conditions characterized by inflammation and mucosal atrophy, predisposing individuals to gastric malignancies, including neuroendocrine tumors (NET) and adenocarcinoma (AC). While the association with NET is well-established, the link to AC remains less clear. This study aims to estimate the 5- and 10-year cumulative incidence of NET, neuroendocrine carcinoma (NEC), and AC in patients with AG, and identify risk factors for progression.
Methods:
An IRB-approved retrospective cohort study of patients diagnosed with AG across a large academic referral center from 2010 to 2023, was conducted. Inclusion criteria required at least one upper endoscopy confirming AG diagnosis. Manual chart review extracted patient and disease relevant variables including demographics, endoscopic findings, and conventional gastric cancer risk factors. Descriptive statistics were reported as median and interquartile range (IQR) or number and frequency. Kaplan-Meier analyses were used to calculate cumulative incidence.
Results:
After reviewing 569 cases, a total of 244 patients with AG were identified. After a median follow-up of 6.47 (3.68-10.79) years, 39 (15.98%) NET, 1 (0.41%) NEC, and 17 (6.96%) AC were diagnosed. Only one patient had overlapping diagnoses of NET and AC. The median age at diagnosis of NET was 59.1 years (IQR 51.9-68.6), and 72.98 years (IQR 66.5-79.2) for AC. After excluding patients with a diagnosis of NET, NEC, or AC at initial endoscopy, there were 216 patients at risk for developing malignancy. Of these, 16 (7.41%) developed NET, 1 (0.46%) developed NEC, and 11 (5.09%) developed AC. Median time to diagnosis was 21.4 (5.7-107.8) months for NET and 8 (5.1-61.8) months for AC. The 5-year cumulative risk was 4.6% for NET and 3.7% for AC, while the 10-year cumulative risk was 6.0% for NET and 4.6% for AC.
Significant risk factors for NET development included hypergastrinemia (present in 84.6% of cases vs. 25.9% of non-cases, p < 0.001), autoimmune disease (69.2% vs. 43.4%, p = 0.005), female gender (74.4% vs. 61.0%, p = 0.01), and B12 deficiency (69.2% vs. 43.4%, p = 0.005). For AC, significant predictors included a history of peptic ulcer (76.5% vs. 33.0%, p = 0.003) and male gender (64.7% vs. 34.8%, p = 0.012) (Table 1, Table 2).
Conclusion:
These findings highlight the significant risk of developing NET and AC in patients with AG, emphasizing the importance of long-term endoscopic surveillance. Distinct differences in age at diagnosis, hypergastrinemia, autoimmune disease prevalence, and peptic ulcer history suggest that a tailored approach to endoscopic monitoring could enhance early detection and outcomes.

Table 1 Univariate analysis of risk factors for NET development in atrophic gastritis

Table 2 Univariate analysis of risk factors for AC development in atrophic gastritis

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