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High impact of methylation accumulation on metachronous gastric cancer: 5-year follow-up of a multicentre prospective cohort study
  1. Masahiro Maeda1,2,
  2. Takeshi Nakajima3,
  3. Ichiro Oda3,
  4. Taichi Shimazu4,
  5. Nobutake Yamamichi5,
  6. Takao Maekita6,
  7. Kiyoshi Asada1,
  8. Chizu Yokoi3,7,
  9. Takayuki Ando1,
  10. Takeichi Yoshida6,
  11. Sohachi Nanjo1,
  12. Mitsuhiro Fujishiro5,
  13. Takuji Gotoda3,8,
  14. Masao Ichinose6,
  15. Toshikazu Ushijima1
  1. 1Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
  2. 2Department of Gastrointestinal Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  3. 3Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
  4. 4Prevention Division, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
  5. 5Department of Gastroenterology, University of Tokyo, Tokyo, Japan
  6. 6Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
  7. 7Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
  8. 8Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
  1. Correspondence to Dr Toshikazu Ushijima, Division of Epigenomics, National Cancer Center Research Institute, Tokyo 104-0045, Japan; tushijim{at}

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We recently published in your journal a 3-year multicentre prospective cohort study demonstrating the usefulness of an epigenetic cancer risk marker for gastric metachronous cancers.1 This study achieved the first proof of concept of epigenetic cancer risk diagnosis in any type of cancer but, due to the short follow-up period, a relatively small number of events were observed, resulting in a marginally significant difference (p=0.042). It was anticipated that a longer follow-up could lead to a clearer difference and HR with a smaller 95% CI. We now report the 5-year follow-up data, which show highly significant results.

Among the 826 enrolled patients, 795 patients received annual follow-ups by endoscopy for a median period of 5.46 years (IQR: 3.95–6.09). By the end, 133 patients had developed a metachronous gastric cancer. Among them, 116 patients developed a metachronous gastric cancer detected 1 year after the enrolment (authentic metachronous cancer).

Statistical analyses were conducted in the same manner as previously …

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