Impact of Prior Upper Endoscopy on Gastric Cancer Stage and Survival in Older Adults

Gastric cancer outcomes remain poor in the United States, with 36% 5-year survival and more than a third of cases diagnosed at an advanced stage. This study explores the impact of prior esophagogastroduodenoscopy (EGD) on gastric cancer stage at diagnosis and survival in an older Medicare-enrolled US population.

The Surveillance, Epidemiology, and End Results-Medicare database was queried from 1999 to 2018 for patients with gastric cancer 68 years of age or older with an EGD claim (Prior EGD) or without an EGD claim (No Prior EGD) 6-36 months before gastric cancer diagnosis. Comparing Prior EGD with No Prior EGD, logistic regression was used to estimate the odds of early-stage ( in situ /local) and regional-stage vs distant-stage gastric cancer. Cox proportional hazards and Fine-Gray subdistribution hazard models were developed to estimate overall and gastric cancer-specific survival, respectively.

In 15,871 patients with gastric cancer, 12.1% had Prior EGD (n = 1,916). Patients with Prior EGD had a 2-fold increased odds of early-stage gastric cancer compared with No Prior EGD (adjusted odds ratio: 2.05; 95% confidence interval [CI]: 1.82-2.31). Compared with No Prior EGD, Prior EGD was associated with a lower hazard of death for overall (adjusted hazard ratio: 0.78, 95% CI: 0.74-0.83) and cancer-specific (adjusted subdistribution hazard ratio: 0.64, 95% CI: 0.64-0.69) survival.

Prior EGD is associated with earlier stage and improved survival in older adults. This study supports further research into endoscopic screening in the United States across younger age groups and diverse populations and healthcare settings.