Failing to adapt – the ageing immune system's role in cancer pathogenesis

SummaryA person's risk of developing cancer rises exponentially with age, an increase that is widely considered to result from cumulative exposure to mutagenic agents. However, cancer incidence rates decelerate and plateau beyond 85 years of age and numerous malignant pathologies peak in incidence during early or middle life, indicating an important role for additional factors in controlling the timing and nature of cancer development. Given that immune function is known to decrease with age, malignant neoplastic change may be induced by increased chronic infection and the onset of a pervasive low grade inflammatory environment. This article discusses in detail the ageing immune system's role in cancer pathogenesis and demonstrates that key polymorphisms coding for relatively low pro-inflammatory cytokine production act to protect some populations from age-induced neoplastic transformation.

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Gastric Hyperplastic Polyps: A Benign Entity? Analysis of Recurrence and Neoplastic Transformation in a Cohort Study

GE Portuguese Journal of Gastroenterology ◽

10.1159/000514714 ◽

2021 ◽

pp. 1-8

Author(s):

Mafalda João ◽

Miguel Areia ◽

Susana Alves ◽

Luís Elvas ◽

Filipe Taveira ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Cohort Study ◽

Intestinal Metaplasia ◽

Endoscopic Resection ◽

Neoplastic Transformation ◽

Low Grade ◽

Hyperplastic Polyps ◽

Adjacent Mucosa ◽

Neoplastic Change

Introduction: Hyperplastic polyps represent 30–93% of all gastric epithelial polyps. They are generally detected as innocuous incidental findings; however, they have a risk of neoplastic transformation and recurrence. Frequency and risk factors for neoplastic transformation and recurrence are not well established and are fields of ongoing interest. This study aims to evaluate the frequency of and identify the risk factors for recurrence and neoplastic change of gastric hyperplastic polyps (GHP). Methods: A single-centre retrospective cohort study including consecutive patients who underwent endoscopic resection of GHP from January 2009 to June 2020. Demographic, endoscopic, and histopathologic data was retrieved from the electronic medical records. Results: A total of 195 patients were included (56% women; median age 67 [35–87] years). The median size of GHP was 10 (3–50) mm, 62% (n = 120) were sessile, 61% (n = 119) were located in the antrum, and 36% (n = 71) had synchronous lesions. Recurrence rate after endoscopic resection was 23% (n = 26). In multivariate analysis, antrum location was the only risk factor for recurrence (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.1–8.1). Overall, 5.1% (n = 10) GHP showed neoplastic transformation, with low-grade dysplasia in 5, high-grade dysplasia in 4, and adenocarcinoma in 1. In multivariate analysis, a size >25 mm (OR 84; 95% CI 7.4–954) and the presence of intestinal metaplasia (OR 7.6; 95% CI 1.0–55) and dysplasia (OR 86; 95% CI 10–741) in adjacent mucosa were associated with an increased risk of neoplastic transformation. Recurrence was not associated with neoplastic transformation (OR 1.1; 95% CI 0.2–5.9). Discussion: Our results confirmed the risk of recurrence and neoplastic transformation of GHP. Antrum location was a predictor of recurrence. The risk of neoplastic change was increased in large lesions and with intestinal metaplasia and dysplasia in adjacent mucosa. More frequent endoscopic surveillance may be required in these subgroups of GHP.

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