Decline of gastric cancer mortality in common variable immunodeficiency in the years 2018-2022

Cinzia Milito; Federica Pulvirenti; Giulia Garzi; Eleonora Sculco; Francesco Cinetto; Davide Firinu; Gianluca Lagnese; Alessandra Punziano; Claudia Discardi; Giulia Costanzo; Carla Felice; Giuseppe Spadaro; Simona Ferrari; Isabella Quinti

doi:10.3389/fimmu.2023.1231242

Decline of gastric cancer mortality in common variable immunodeficiency in the years 2018-2022

Front Immunol. 2023 Oct 6:14:1231242. doi: 10.3389/fimmu.2023.1231242. eCollection 2023.

Affiliations

¹ Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
² Reference Center for Primary Immune Deficiencies, AOU Policlinico Umberto I, Rome, Italy.
³ Rare Diseases Referral Center, Internal Medicine 1, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy.
⁴ Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
⁵ Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
⁶ Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Abstract

Introduction: In patients with Common Variable Immunodeficiency, malignancy has been reported as the leading cause of death in adults, with a high risk of B-cell lymphomas and gastric cancer.

Methods: We conducted a five-year prospective study aiming to update the incidence and mortality of gastric cancer and the incidence of gastric precancerous lesions in 512 CVID patients who underwent a total of 400 upper gastrointestinal endoscopies.

Results: In the pre-pandemic period, 0.58 endoscopies were performed per patient/year and in the COVID-19 period, 0.39 endoscopies were performed per patient/year. Histology revealed areas with precancerous lesions in about a third of patients. Patients who had more than one gastroscopy during the study period were more likely to have precancerous lesions. Two patients received a diagnosis of gastric cancer in the absence of Helicobacter pylori infection. The overall prevalence of Helicobacter pylori infection in biopsy specimens was 19.8% and related only to active gastritis. Among patients who had repeated gastroscopies, about 20% progressed to precancerous lesions, mostly independent of Helicobacter pylori.

Discussion: While gastric cancer accounted for one in five deaths from CVID in our previous survey, no gastric cancer deaths were recorded in the past five years, likely consistent with the decline in stomach cancer mortality observed in the general population. However, during the COVID-19 pandemic, cancer screening has been delayed. Whether such a delay or true decline could be the reason for the lack of gastric cancer detection seen in CVID may become clear in the coming years. Due to the high incidence of precancerous lesions, we cannot rely on observed and predicted trends in gastric cancer mortality and strongly recommend tailored surveillance programs.

Keywords: COVID-19; Helicobacter pylori; common variable immunodeficiency; endoscopy; gastric adenocarcinoma; gastric cancer; mortality; screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Common Variable Immunodeficiency* / complications
Common Variable Immunodeficiency* / epidemiology
Gastroscopy / adverse effects
Helicobacter Infections* / complications
Helicobacter Infections* / diagnosis
Helicobacter Infections* / epidemiology
Helicobacter pylori*
Humans
Pandemics
Precancerous Conditions* / pathology
Prospective Studies
Stomach Neoplasms* / pathology

Grants and funding

The research leading to these results has received funding from the European Union - NextGenerationEU through the Italian Ministry of University and Research under PNRR - M4C2-I1.3 Project PE_00000019 “HEAL ITALIA” to IQ CUP: B53C22004000006.