Age-dependent effects of gastric cancer screening endoscopy on mortality: a nationwide cohort study

초록

Background Endoscopic screening for gastric cancer reduces mortality, but the optimal upper age limit and modifying role of comorbidity remain unclear.<br /> Methods This nationwide retrospective cohort study used the Korean National Health Insurance Service database linked to national mortality records. Individuals aged >= 40 years who underwent screening esophagogastroduodenoscopy between 2005 and 2010 were included and propensity score-matched to non-screened controls. The primary outcome was gastric cancer-specific mortality. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Hazard ratios (HRs) were estimated in the matched cohort.<br /> Results Among 555 904 propensity score-matched individuals (277 952 per group), gastric cancer-specific mortality HRs showed an age-dependent gradient: <1.0 at 50-59 years (HR 0.56, 95%CI 0.34-0.92), 60-64 (0.65, 0.40-1.07), and 65-69 (0.82, 0.58-1.17); close to 1.0 at 70-74 (0.99, 0.75-1.30) and 75-79 (0.92, 0.68-1.24); and elevated at >= 80 years (2.21, 1.49-3.27). Comorbidity further modified this association: HRs were <1.0 in individuals with CCI <3 (0.86, 0.74-1.01) but elevated in those with CCI >= 3 (1.88, 1.42-2.49). In age-CCI analyses, point estimates favored screening across age groups up to age 75-79 years among individuals with CCI 0, but HRs exceeded 1.0 in most age groups with CCI >= 3. Post-endoscopy respiratory or cerebrocardiovascular events increased with age and comorbidity.<br /> Conclusion The mortality benefit of gastric cancer screening endoscopy diminished with advancing age and comorbidity burden, becoming questionable beyond age 70. At age >= 80 or in individuals with substantial comorbidity, potential harms may outweigh benefits.

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