Helicobacter pylori eradication prevents secondary gastric cancer in patients with mild-to-moderate atrophic gastritis
Helicobacter pylori eradication prevents secondary gastric cancer in patients with mild-to-moderate atrophic gastritis
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DOI：
10.1111/jgh.15396
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发表时间：
2021-02-01
影响因子：
4.1
通讯作者：
Takehara, Tetsuo
中科院分区：
文献类型：
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作者：
Kato, Minoru;Hayashi, Yoshito;Takehara, Tetsuo
背景和目的：根除幽门螺杆菌是否可以预防早期胃癌内镜切除（ER）后的异时复发仍存在争议。这项多中心回顾性研究旨在通过对患者萎缩性胃炎的基线程度进行分层来评估幽门螺杆菌根除的长期（> 5年）效果。方法：总共483例因早期胃癌接受ER治疗的幽门螺杆菌阳性患者被分为两组：（i）ER后1年内成功根除幽门螺杆菌的患者（根除组，n = 294）和(ii) 幽门螺杆菌根除失败或未尝试的患者（未根除组，n = 189）。比较两组所有患者、轻度至中度萎缩性胃炎患者 (n = 182) 和重度萎缩性胃炎患者 (n = 301) 的异时性胃癌累积发病率。 结果：在中位随访 5.2 年（范围 1.1-14.8）期间，根除组中有 52 名患者（17.7%）发生异时性癌症，而未根除组中有 35 名患者 (18.5%)（P = 0.11，对数秩检验）。在轻中度萎缩性胃炎患者中（根除组和非根除组分别为 111 例和 71 例），根除组异时癌的累计发生率显着低于非根除组（P = 0.03，时序检验）。然而，重度萎缩性胃炎患者的组间差异不显着（P = 0.69，时序检验）。结论：根除幽门螺杆菌对轻中度萎缩性胃炎患者异时性胃癌的发生具有预防作用。
Background and Aim: 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: 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: 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: Helicobacter pylori eradication had a preventive effect on the development of metachronous gastric cancer in patients with mild-to-moderate atrophic gastritis.