Statins Were Associated with a Reduced Gastric Cancer Risk in Patients with Eradicated Helicobacter Pylori Infection: A Territory-Wide Propensity Score Matched Study
Statins Were Associated with a Reduced Gastric Cancer Risk in Patients with Eradicated Helicobacter Pylori Infection: A Territory-Wide Propensity Score Matched Study
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DOI：
10.1158/1055-9965.epi-19-1044
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发表时间：
2020-02-01
影响因子：
3.8
通讯作者：
Leung, Wai K.
中科院分区：
文献类型：
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作者：
Cheung, Ka Shing;Chan, Esther W.;Leung, Wai K.
背景：即使根除幽门螺杆菌，个体仍可能发生胃癌。我们的目的是研究他汀类药物对幽门螺杆菌根除者胃癌发展的影响。方法：在这项回顾性队列研究中，所有在2003年至2012年间接受克拉霉素三联疗法的成人受试者都使用了一个全国性的电子医疗数据库。从幽门螺杆菌治疗的索引日期开始观察患者，并在胃癌诊断、死亡或2015年12月（研究结束日期）进行审查。斯大林使用被定义为>=索引日期后180天的使用。排除标准包括索引日期后一年内诊断为胃癌，既往胃癌或胃切除术，幽门螺杆菌治疗失败。通过竞争风险回归和倾向评分（PS）分析，匹配19个变量（年龄、性别、合并症和其他药物使用，包括质子泵抑制剂、非甾体抗炎药、阿司匹林、环氧化酶-2抑制剂和二甲双胍），计算他汀类药物治疗胃癌的亚分布风险比（SHR）。结果：在7.6年的中位随访期间（四分位数范围为5.1-10.3），63,605例患者中有169例（0.27%）发生胃癌，发病率为每10,000人年3.5例。在22,870名ps匹配的受试者中，他汀类药物与较低的胃癌风险相关（SHR = 0.34； 95%可信区间为0.19-0.61），且以持续时间和剂量-反应方式相关（p趋势< 0.05）。结论：在幽门螺杆菌根除患者中，他汀类药物与较低的胃癌风险存在持续时间和剂量反应关系。影响：本研究为他汀类药物作为预防胃癌的化学预防剂在根除幽门螺旋杆菌患者中的额外益处提供了证据。
Background: Individuals may still develop gastric cancer even after Helicobacter pylori eradication. We aimed to investigate statin effect on gastric cancer development in H. pylori-eradicated subjects.Methods: All adult subjects who were prescribed clarithromycin-based triple therapy between 2003 and 2012 were identified in this retrospective cohort study utilizing a territory-wide electronic healthcare database. Patients were observed from index date of H. pylori therapy, and censored at gastric cancer diagnosis, death, or December 2015 (study end date). Stalin use was defined as >= 180-day use after index date. Exclusion criteria included gastric cancer diagnosed within the first year after index date, previous gastric cancer or gastrectomy, and H. pylori treatment failure. Subdistribution hazard ratio (SHR) of gastric cancer with statins was calculated by competing risk regression with propensity score (PS) analysis matching 19 variables (age, sex, comorbidities, and other drug usage, including proton pump inhibitors, nonsteroidal anti-inflammatory drugs, aspirin, cyclooxygenase-2 inhibitors, and metformin).Results: During a median follow-up of 7.6 years (interquartile range = 5.1-10.3), 169 (0.27%) of 63,605 patients developed gastric cancer at an incidence rate of 3.5 per 10,000 person-years. Among 22,870 PS-matched subjects, statins were associated with a lower gastric cancer risk (SHR = 0.34; 95% confidence interval, 0.19-0.61), in a duration- and dose-response manner (P-trend < 0.05).Conclusions: Statins were associated with a lower gastric cancer risk in a duration- and dose-response manner among H. pylori-eradicated patients.Impact: This study provides evidence on the additional benefits of statins as chemopreventive agents against gastric cancer among H. pylon-eradicated patients.