Prevalence of Gastric Precursor Lesions in Countries with Differential Gastric Cancer Burden: A Systematic Review & Meta-Analysis

Abstract:

Background and Aims

The prevalence of precursor lesions for gastric cancer (GC) and the differential burden between countries of varying GC risk is not well understood. We conducted a systematic review and meta-analysis to estimate the global prevalence of precursor lesions.

Methods

We estimated the prevalence of atrophic gastritis (AG), gastric intestinal metaplasia (IM), and dysplasia in regions with low, medium, and high-GC incidence. Since IM is an advanced manifestation of AG, we assessed the prevalence of less advanced precursors regardless of the presence of more advanced lesions. Prevalence was sub-stratified by Helicobacter pylori (H.pylori) infection, symptomatology, and period (<2000, 2000-2010, and >2010).

Results

Among the 582 articles which underwent full-text review, 166 studies met inclusion criteria. The global prevalence estimates of AG, IM, and dysplasia were 25.4%, 16.2% and 2.0%, based on 126 studies that reported the prevalence of less advanced precursors regardless of the presence of more advanced lesions. The prevalence of all precursor lesions was higher in high- and medium- compared to low-GC incidence countries (p<0.01). Prevalence of AG and IM was significantly higher among H.pylori-infected individuals (p<0.01), but not statistically different between symptomatic and asymptomatic individuals (p>0.17). All precursors demonstrated a secular decrease in prevalence over time.

Conclusions

Gastric precursor lesions have differences in prevalence in regions with differential GC incidence and are associated with H.pylori infection. Given the substantial prevalence of precursor lesions in both symptomatic and asymptomatic individuals, symptomatic evaluation may not be sufficient to identify individuals at risk. These estimates provide important insights for tailoring GC prevention strategies.