Helicobacter pylori eradication prevents secondary gastric cancer in patients with mild-to-moderate atrophic gastritis.
Helicobacter pylori
atrophic gastritis
endoscopic resection
gastric cancer
metachronous cancer
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
revised:
30
11
2020
received:
20
05
2020
accepted:
27
12
2020
pubmed:
7
1
2021
medline:
22
12
2021
entrez:
6
1
2021
Statut:
ppublish
Résumé
Whether Helicobacter pylori eradication prevents metachronous recurrence after endoscopic resection (ER) of early gastric cancer remains controversial. This multicenter retrospective study aimed to evaluate the long-term (> 5 years) effects of H. pylori eradication by stratifying patients' baseline degrees of atrophic gastritis. A total of 483 H. pylori-positive patients who had undergone ER for early gastric cancer were divided into two groups-(i) those having undergone successful H. pylori eradication within 1 year after ER (eradicated group, n = 294) and (ii) those with failed or not attempted H. pylori eradication (non-eradicated group, n = 189). The cumulative incidences of metachronous gastric cancer between the two groups were compared for all patients, for patients with mild-to-moderate atrophic gastritis (n = 182), and for patients with severe atrophic gastritis (n = 301). During a median follow-up of 5.2 years (range 1.1-14.8), metachronous cancer developed in 52 (17.7%) patients in the eradicated group and in 35 (18.5%) patients in the non-eradicated group (P = 0.11, log-rank test). In patients with mild-to-moderate atrophic gastritis (111 and 71 in the eradicated and non-eradicated groups, respectively), the cumulative incidence of metachronous cancer was significantly lower in the eradicated group than that in the non-eradicated group (P = 0.03, log-rank test). However, no significant intergroup difference was observed in patients with severe atrophic gastritis (P = 0.69, log-rank test). Helicobacter pylori eradication had a preventive effect on the development of metachronous gastric cancer in patients with mild-to-moderate atrophic gastritis.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
Whether Helicobacter pylori eradication prevents metachronous recurrence after endoscopic resection (ER) of early gastric cancer remains controversial. This multicenter retrospective study aimed to evaluate the long-term (> 5 years) effects of H. pylori eradication by stratifying patients' baseline degrees of atrophic gastritis.
METHODS
METHODS
A total of 483 H. pylori-positive patients who had undergone ER for early gastric cancer were divided into two groups-(i) those having undergone successful H. pylori eradication within 1 year after ER (eradicated group, n = 294) and (ii) those with failed or not attempted H. pylori eradication (non-eradicated group, n = 189). The cumulative incidences of metachronous gastric cancer between the two groups were compared for all patients, for patients with mild-to-moderate atrophic gastritis (n = 182), and for patients with severe atrophic gastritis (n = 301).
RESULTS
RESULTS
During a median follow-up of 5.2 years (range 1.1-14.8), metachronous cancer developed in 52 (17.7%) patients in the eradicated group and in 35 (18.5%) patients in the non-eradicated group (P = 0.11, log-rank test). In patients with mild-to-moderate atrophic gastritis (111 and 71 in the eradicated and non-eradicated groups, respectively), the cumulative incidence of metachronous cancer was significantly lower in the eradicated group than that in the non-eradicated group (P = 0.03, log-rank test). However, no significant intergroup difference was observed in patients with severe atrophic gastritis (P = 0.69, log-rank test).
CONCLUSIONS
CONCLUSIONS
Helicobacter pylori eradication had a preventive effect on the development of metachronous gastric cancer in patients with mild-to-moderate atrophic gastritis.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
2083-2090Informations de copyright
© 2021 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Correa P. Chronic gastritis as a cancer precursor. Scand. J. Gastroenterol. 1984; 104: 131-136.
Uemura N, Okamoto S, Yamamoto S et al. Helicobacter pylori infection and the development of gastric cancer. N. Engl. J. Med. 2001; 345: 784-789.
de Vries AC, van Grieken NC, Looman CW et al. Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology 2008; 134: 945-952.
Uemura N, Mukai T, Okamoto S et al. Effect of Helicobacter pylori eradication on subsequent development of cancer after endoscopic resection of early gastric cancer. Cancer Epidemiol. Biomarkers Prev. 1997; 6: 639-642.
Fukase K, Kato M, Kikuchi S et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 2008; 372: 392-397.
Choi IJ, Kook MC, Kim YI et al. Helicobacter pylori therapy for the prevention of metachronous gastric cancer. N. Engl. J. Med. 2018; 378: 1085-1095.
Choi JM, Kim SG, Choi J et al. Effect of Helicobacter pylori eradication for metachronous gastric cancer prevention: a randomized controlled trial. Gastrointest. Endosc. 2018; 88: 475-485.
Bae SE, Jung HY, Kang J et al. Effect of Helicobacter pylori eradication on metachronous recurrence after endoscopic resection of gastric neoplasm. Am. J. Gastroenterol. 2014; 109: 60-67.
Kwon YH, Heo J, Lee HS et al. Failure of Helicobacter pylori eradication and age are independent risk factors for recurrent neoplasia after endoscopic resection of early gastric cancer in 283 patients. Aliment. Pharmacol. Ther. 2014; 39: 609-618.
Kim YI, Choi IJ, Kook MC et al. The association between Helicobacter pylori status and incidence of metachronous gastric cancer after endoscopic resection of early gastric cancer. Helicobacter 2014; 19: 194-201.
Kato M, Nishida T, Yamamoto K et al. Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicenter retrospective cohort study by Osaka University ESD study group. Gut 2013; 62: 1425-1432.
Maehata Y, Nakamura S, Fujisawa K et al. Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer. Gastrointest. Endosc. 2012; 75: 39-46.
Choi JM, Kim SG, Yoon H et al. Eradication of Helicobacter pylori after endoscopic resection of gastric tumor does not reduce incidence of metachronous gastric carcinoma. Clin. Gastroenterol. Hepatol. 2014; 12: 793-800.
Ami R, Hatta W, Iijima K et al. Factors associated with metachronous gastric cancer development after endoscopic submucosal dissection for early gastric cancer. J. Clin. Gastroenterol. 2017; 51: 494-499.
Wong BC, Lam SK, Wong WM et al. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA 2004; 291: 187-194.
Shichijo S, Hirata Y, Niikura R et al. Histologic intestinal metaplasia and endoscopic atrophy are predictors of gastric cancer development after Helicobacter pylori eradication. Gastrointest. Endosc. 2016; 84: 618-624.
Yanaoka K, Oka M, Ohata H et al. Eradication of Helicobacter pylori prevents cancer development in subjects with mild gastric atrophy identified by serum pepsinogen levels. Int. J. Cancer 2009; 125: 2697-2703.
Take S, Mizuno M, Ishiki K et al. The long-term risk of gastric cancer after the successful eradication of Helicobacter pylori. J. Gastroenterol. 2011; 46: 318-324.
Kaji K, Hashiba A, Uotani C et al. Grading of atrophic gastritis is useful for risk stratification in endoscopic screening for gastric cancer. Am. J. Gastroenterol. 2019; 114: 71-79.
Chen HN, Wang Z, Li X et al. Helicobacter pylori eradication cannot reduce the risk of gastric cancer in patients with intestinal metaplasia and dysplasia: evidence from a meta-analysis. Gastric Cancer 2016; 16: 166-175.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 2017; 20: 1-9.
Kato M, Ota H, Okuda M et al. Guidelines for the management of Helicobacter pylori infection in Japan: 2016 Revised Edition. Helicobacter 2019; 24: e12597.
Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy 1969; 3: 87-97.
Kono S, Gotoda T, Yoshida S et al. Can endoscopic atrophy predict histologic atrophy? Historical study in United Kingdom and Japan. World J. Gastroenterol. 2015; 21: 13113-13123.
Schlemper RJ, Riddell RH, Kato Y et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255.
Take S, Mizuno M, Ishiki K et al. Risk of gastric cancer in the second decade of follow-up after Helicobacter pylori eradication. J. Gastroenterol 2020; 55: 289-290.