Helicobacter pylori infection, chronic atrophic gastritis and risk of stomach and esophagus cancer: Results from the prospective population-based ESTHER cohort study
Helicobacter pylori infection, chronic atrophic gastritis and risk of stomach and esophagus cancer: Results from the prospective population-based ESTHER cohort study
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DOI：
10.1002/ijc.32610
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发表时间：
2019-08-29
影响因子：
6.4
通讯作者：
Brenner, Hermann
中科院分区：
文献类型：
--
作者：
Holleczek, Bernd;Schoettker, Ben;Brenner, Hermann
幽门螺杆菌（H. pylori）感染被认为是胃癌的主要原因。它还与食管腺癌风险降低相关。在一项包括9,949名受试者、平均观察时间为13.8年的大型前瞻性人群队列研究中，我们根据H.幽门螺杆菌感染和慢性萎缩性胃炎（CAG）的存在。通过考克斯比例风险模型得出的发病率和风险比（HR），并对相关混杂因素进行了校正。幽门螺杆菌和细胞毒素相关基因A（CagA）抗体和CAG的存在分别基于基线时的血清学标志物。在随访期间，观察了30例非贲门胃癌和33例食管癌。感染H. pylori不表达和表达CagA分别与非贲门胃癌发病率增加5.2倍（95%可信区间1.00-27.1）和18.2倍（4.3-77.4）相关。食管腺癌的危险性降低了0.65倍（HR 0.35，0.12-0.97）。幽门螺杆菌感染者在感染CagA的参与者中表达H. pylori感染者中，轻、中、重度CAG分别与胃癌发病率增加6.4倍（1.3-31.0）和11.8倍（3.1-45.4）相关。这项前瞻性人群队列研究的结果可能为正在进行的H.幽门相关的癌症本研究结果可进一步加强H.幽门螺杆菌感染者和关于H.幽门螺杆菌筛查和治疗中的老年人在西方人口。
Helicobacter pylori (H. pylori) infection is considered as principal cause of gastric cancer. It is further associated with a reduced risk of esophageal adenocarcinomas. In a large prospective population-based cohort study including 9,949 subjects with average observation time of 13.8 years, we assessed the risk of invasive gastric and esophageal cancer according to H. pylori infection and presence of chronic atrophic gastritis (CAG). Incidence rates and hazard ratios (HR) derived by Cox proportional hazards models and adjusted for relevant confounders were derived by seroprevalence of H. pylori and cytotoxin-associated gene A (CagA) antibodies and presence of CAG based on serological markers at baseline, respectively. During follow-up, 30 cases of noncardia gastric cancer and 33 cases of esophageal cancer were observed. Infection by H. pylori without and with expression of CagA was associated with a 5.2-fold (95% confidence interval 1.00-27.1) and an 18.2-fold (4.3-77.4) increase of noncardia gastric cancer incidence. A 0.65-fold decreased risk of esophageal adenocarcinomas (HR 0.35, 0.12-0.97) was observed among H. pylori-infected individuals. In participants infected with CagA expressed H. pylori, the presence of mild/moderate and severe CAG was associated with a 6.4-fold (1.3-31.0) and an 11.8-fold (3.1-45.4) increase of gastric cancer incidence, respectively. The results of this prospective population-based cohort study may contribute relevant evidence to the ongoing research of H. pylori-related cancers. The results may furthermore enhance the empirical basis for risk stratification among H. pylori-infected people and for recommendations regarding H. pylori screening and treatment among older adults in a Western population.