Endoscopic surveillance in hereditary diffuse gastric cancer – Authors’ reply

We read with interest the Article by Bilal Asif and colleagues, 1 Asif B Sarvestani AL Gamble LA et al. Cancer surveillance as an alternative to prophylactic total gastrectomy in hereditary diffuse gastric cancer: a prospective cohort study. Lancet Oncol. 2023; 24: 383-391 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar which, together with our Article, 2 Lee CYC Olivier A Honing J et al. Endoscopic surveillance with systematic random biopsy for the early diagnosis of hereditary diffuse gastric cancer: a prospective 16-year longitudinal cohort study. Lancet Oncol. 2023; 24: 107-116 Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar provides increasing evidence in support of endoscopic surveillance for managing individuals with hereditary diffuse gastric cancer syndrome. Asif and colleagues report that among 120 individuals with a CDH1 pathogenic variant who underwent endoscopic surveillance, only two (2%) developed cancer requiring therapeutic gastrectomy (pT3N0). Moreover, of the 98 individuals receiving prophylactic surgery, 95 (97%) had evidence of pT1a or pT1is disease. 1 Asif B Sarvestani AL Gamble LA et al. Cancer surveillance as an alternative to prophylactic total gastrectomy in hereditary diffuse gastric cancer: a prospective cohort study. Lancet Oncol. 2023; 24: 383-391 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar Similarly, in our prospective cohort, we observed one case of advanced cancer in an individual who refused timely surgery, 3 Mi EZ Mi EZ di Pietro M et al. Comparative study of endoscopic surveillance in hereditary diffuse gastric cancer according to CDH1 mutation status. Gastrointest Endosc. 2018; 87: 408-418 Summary Full Text Full Text PDF PubMed Scopus (73) Google Scholar and pT1a carcinoma in 89% of patients undergoing prophylactic surgery. 2 Lee CYC Olivier A Honing J et al. Endoscopic surveillance with systematic random biopsy for the early diagnosis of hereditary diffuse gastric cancer: a prospective 16-year longitudinal cohort study. Lancet Oncol. 2023; 24: 107-116 Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar Given the widespread presence of occult pT1a disease, Asif and colleagues questioned the utility of random biopsies, redirecting the aim of surveillance from prevention to detection of progressive carcinoma (stage T1b or higher). Endoscopic surveillance in hereditary diffuse gastric cancerWe read with great interest the Article by Bilal Asif and colleagues.1 The authors conclude that surveillance is a viable alternative to total gastrectomy for individuals with CDH1 variants who declined total gastrectomy. Although we commend the authors for recruiting such a large cohort, we have concerns about the feasibility of the study, and the generalisability of the study findings. Full-Text PDF Cancer surveillance as an alternative to prophylactic total gastrectomy in hereditary diffuse gastric cancer: a prospective cohort studyIn our cohort, endoscopic cancer surveillance was an acceptable alternative to surgery in individuals with CDH1 variants who declined total gastrectomy. The low rate of incident tumours (>T1a) suggests that surveillance might be a rational alternative to surgery in individuals with CDH1 variants. Full-Text PDF Endoscopic surveillance in hereditary diffuse gastric cancer – Authors’ replyWe are pleased to read the Correspondence pieces generated by our Article.1 We agree that both patients and clinicians should understand the limitations of endoscopic surveillance for patients with hereditary diffuse gastric cancer with germline CDH1 variants. Kaso Ari and colleagues raise questions regarding the feasibility of our study, and the generalisability of our findings. Our study shows that endoscopic surveillance for patients with hereditary diffuse gastric cancer is practicable, although we acknowledge that its application might be limited by local resources and biases. Full-Text PDF Endoscopic surveillance in hereditary diffuse gastric cancerWe read with interest the Article by Bilal Asif and colleagues.1 In this study, 120 (44%) of 270 enrolled patients with germline CDH1 variants who declined prophylactic gastrectomy were allocated to a surveillance group to receive serial endoscopic examinations. Over a median of 31 months (IQR 17·1–42·1), superficial cancer was detected in 76 (63%) patients and invasive lesions in two (2%) patients in the surveillance group. 98 (36%) of 270 patients received prophylactic total gastrectomy, including 29 (24%) who had undergone at least two endoscopic examinations. Full-Text PDF