Incidence and risk of gastric neuroendocrine tumors and adenocarcinoma in patients with atrophic gastritis/pernicious anemia.

BACKGROUND

Atrophic gastritis (AG), particularly in the context of autoimmune mechanisms or chronic Helicobacter pylori infection, is a recognized precursor to gastric neoplasia. However, surveillance strategies remain inconsistent. This study aimed to determine the cumulative incidence and risk factors for gastric neuroendocrine tumor (gNET) and adenocarcinoma (AC) in a large United States-based cohort of patients with AG.

METHODS

A retrospective cohort study of 224 patients diagnosed with AG at a single tertiary center between 2010 and 2023 was conducted. Patients with prevalent gNET (n = 25) or AC (n = 7) were excluded from respective survival analyses. Kaplan-Meier methods estimated 5- and 10-year cumulative incidence, and univariate Cox regression identified risk factors for neoplastic progression.

RESULTS

Among 199 patients at risk of gNET, the 5- and 10-year cumulative incidence rates were 6% and 18%, respectively. Hypergastrinemia and alcohol use disorder were associated with increased gNET risk. For the 217 patients at risk of AC, the 5- and 10-year cumulative incidence rates were 3% and 9%, respectively. Severe dysplasia and a history of peptic ulcer disease were the strongest predictors of AC. Histologic severity alone was not a reliable predictor of neoplastic progression.

CONCLUSION

Patients with AG face significantly elevated risks of both gNET and AC compared with the general population. Risk stratification based on clinical and biochemical factors - such as hypergastrinemia, alcohol use, and dysplasia - may better inform surveillance strategies than histology alone. These findings support more personalized endoscopic surveillance protocols in high-risk populations with AG.