Risk Factors and Incidence of Gastric Cancer After Detection of Helicobacter pylori Infection: A Large Cohort Study
Risk Factors and Incidence of Gastric Cancer After Detection of Helicobacter pylori Infection: A Large Cohort Study
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检测幽门螺杆菌感染后发生胃癌的危险因素和发病率：一项大型队列研究
DOI：
10.1053/j.gastro.2019.10.019
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发表时间：
2020-02-01
期刊：
影响因子：
29.4
通讯作者：
Goldberg, David S.
中科院分区：
文献类型：
--
作者：
Kumar, Shria;Metz, David C.;Goldberg, David S.
背景与目的：美国几乎所有关于胃腺癌的研究都依赖于国家癌症数据库，其中不包括幽门螺杆菌感染的数据，幽门螺杆菌感染是最众所周知的胃癌危险因素。我们收集了一大批美国患者的数据，以计算在检测到幽门螺杆菌后非近端胃腺癌的发生率和危险因素。次要目标包括确定治疗和根除如何影响癌症风险。方法：我们进行了一项回顾性队列研究，收集了退伍军人健康管理局从1994年1月1日到2018年12月31日期间371,813名确诊为幽门螺杆菌感染的患者(中位年龄62岁，92.3%男性)的数据。主要结果是在检测到幽门螺杆菌感染后30天或更长时间被诊断为远端胃腺癌。我们用竞争风险分析(癌症前死亡作为竞争风险)进行了事件发生时间分析。结果：检测到幽门螺杆菌感染后5、10和20年的累积癌症发病率分别为0.37%、0.5%和0.65%。与癌症相关的因素包括检测到幽门螺杆菌感染时的年龄(亚危险比[SHR]，1.13；95%可信区间[CI]，1.11-1.15；P<；.001)，黑人/非裔美国人(SHR，2.00；95%CI，1.80-2.22)，亚裔(SHR，2.52；95%CI，1.64-3.89)(P<；种族.001)，西班牙裔或拉丁裔(SHR，1.59；95%可信区间1.34-1.87；吸烟史(自发性高血压，1.38；95%可信区间1.25-1.52；P<；.001)。与男性相比，女性患胃腺癌的风险降低(SHR，0.52；95%CI，0.40-0.68；P<；.001)；根据血清抗体阳性检测到幽门螺杆菌感染的患者患癌症的风险也降低(SHR，0.74；95%CI，0.54-1.04；P=.04)。接受幽门螺杆菌感染治疗的患者患胃癌的风险仍然增加(SHR，1.16；95%CI，0.74-1.83；P=.51)，但治疗后证实根除Hp可降低患胃癌的风险(SHR，0.24；95%CI，0.150.41；P<；.001)。结论：在一项对371,813名被诊断为幽门螺杆菌感染的退伍军人的研究中，我们发现少数民族和吸烟者患胃癌的风险显著增加。只有在根除成功的情况下，幽门螺杆菌感染的治疗才能降低风险。需要研究筛查高危人群的效果，并确定诊断、耐药模式和治疗效果的质量措施。
BACKGROUND & AIMS: Nearly all studies of gastric adenocarcinoma in the United States have relied on national cancer databases, which do not include data on Helicobacter pylori infection, the most well-known risk factor for gastric cancer. We collected data from a large cohort of patients in the United States to calculate the incidence of and risk factors for nonproximal gastric adenocarcinomas after detection of H pylori. Secondary aims included identifying how treatment and eradication affect cancer risk. METHODS: We performed a retrospective cohort study, collecting data from the Veterans Health Administration on 371,813 patients (median age 62 years; 92.3% male) who received a diagnosis of H pylori infection from January 1, 1994, through December 31, 2018. The primary outcome was a diagnosis of distal gastric adenocarcinoma 30 days or more after detection of H pylori infection. We performed a time to event with competing risk analysis (with death before cancer as a competing risk). RESULTS: The cumulative incidence of cancer at 5, 10, and 20 years after detection of H pylori infection was 0.37%, 0.5%, and 0.65%, respectively. Factors associated with cancer included older age at time of detection of H pylori infection (subhazard ratio [SHR], 1.13; 95% confidence interval [CI], 1.11-1.15; P < .001), black/African American race (SHR, 2.00; 95% CI, 1.80-2.22), Asian race (SHR, 2.52; 95% CI, 1.64-3.89) (P < .001 for race), Hispanic or Latino ethnicity (SHR, 1.59; 95% CI, 1.34-1.87; P < .001), and history of smoking (SHR, 1.38; 95% CI, 1.25-1.52; P < .001). Women had decreased risk of gastric adenocarcinoma compared with men (SHR, 0.52; 95% CI, 0.40-0.68; P < .001); patients whose H pylori infection was detected based on serum antibody positivity also had a reduced risk of cancer (SHR 0.74; 95% CI, 0.54-1.04; P = .04). Patients who received treatment for their H pylori infection still had an increased risk of gastric cancer (SHR, 1.16; 95% CI, 0.74-1.83; P = .51) but confirmed H pylori eradication after treatment reduced risk of gastric cancer (SHR, 0.24; 95% CI, 0.150.41; P < .001). CONCLUSIONS: In a study of 371,813 veterans with a diagnosis of H pylori infection, we found significantly higher risks of gastric cancer in racial and ethnic minorities and smokers. Treatment of H pylori infection decreased risk only if eradication was successful. Studies are needed on the effects of screening high-risk persons and to identify quality measures for diagnosis, resistance patterns, and treatment efficacy.