Long-term esophageal cancer risk and distinct surveillance intervals after a single endoscopy screening: a multicentre population-based cohort study

BACKGROUND: Endoscopy surveillance is recommended for mild-moderate dysplasia and negative endoscopy findings every 3 years and 5 years, respectively, but evidence is limited. This study aimed to assess long-term esophageal cancer (EC) incidence and mortality after a single endoscopy screening. METHODS: We included individuals at high risk of EC aged 40–69 years who underwent endoscopy screening in 2007–2012 at six centres in rural China and had a baseline diagnosis of negative endoscopy findings, mild dysplasia, or moderate dysplasia. Participants were followed up for EC incidence and mortality. Cumulative incidence and mortality rates of EC were estimated by Kaplan–Meier analyses. Cox regression models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between baseline endoscopy diagnosis and the risk of EC incidence and mortality. EC incidence and mortality after a single endoscopy screening were compared with those of the population in rural China by the standardized incidence ratio (SIR) and standardized mortality ratio (SMR). FINDINGS: A total of 42,827 participants (40,977 with negative endoscopy findings, 1562 with mild dysplasia, and 288 with moderate dysplasia) were included; 268 EC cases and 128 EC deaths were identified during a median follow-up of 10.62 years. The cumulative EC incidence at 10 years was 0.45% (0.38–0.52) in the group with negative endoscopy findings, 2.39% (1.62–3.16) in the mild dysplasia group, and 8.90% (5.57–12.24) in the moderate dysplasia group, and the cumulative EC mortality at 10 years was 0.23% (0.18–0.27), 0.96% (0.46–1.46), and 2.50% (0.67–4.33), respectively. Compared with individuals with negative endoscopy findings, the HRs for EC incidence and mortality in the mild dysplasia group were 3.52 (2.49–4.97) and 2.43 (1.41–4.19), and those in the moderate dysplasia group were 13.18 (8.78–19.76) and 6.46 (3.13–13.29), respectively. The SIR was 0.53 (0.40–0.70) for the group with negative endoscopy findings, 1.95 (1.69–2.24) for the mild dysplasia group, and 6.75 (6.25–7.28) for the moderate dysplasia group, with the SMRs of 0.43 (0.31–0.58), 1.07 (0.88–1.29) and 2.67 (2.36–3.01), respectively. INTERPRETATION: Individuals with negative endoscopy findings after a single endoscopy screening had a lower EC risk than the general population for up to 10.62 years, while those with mild-moderate dysplasia had an elevated risk. Our results support endoscopy surveillance for mild-moderate dysplasia every 3 years and suggest extending the interval to 10 years after a negative endoscopy finding. FUNDING: National Key R&D Programme of China, Special Project of Beijing-Tianjin-Hebei Basic Research Cooperation, and 10.13039/501100012151Sanming Project of Medicine in Shenzhen.