Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer

• Published in: Gastrointestinal endoscopy 2012, Vol.75 (1), p.39-46
• Main Authors: Maehata, Yuji, MD, Nakamura, Shotaro, MD, PhD, Fujisawa, Kiyoshi, MD, Esaki, Motohiro, MD, PhD, Moriyama, Tomohiko, MD, PhD, Asano, Kouichi, MD, PhD, Fuyuno, Yuta, MD, Yamaguchi, Kan, MD, Egashira, Issei, MD, Kim, Hyonji, MD, Kanda, Motonobu, MD, PhD, Hirahashi, Minako, MD, PhD, Matsumoto, Takayuki, MD, PhD
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Digestive system. Abdomen; Disease Eradication; Endoscopy; Female; Gastric Mucosa - pathology; Gastric Mucosa - surgery; Gastritis, Atrophic - complications; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastroscopy; Helicobacter Infections - drug therapy; Helicobacter Infections - prevention & control; Helicobacter pylori; Human bacterial diseases; Humans; Incidence; Infectious diseases; Investigative techniques, diagnostic techniques (general aspects); Kaplan-Meier Estimate; Logistic Models; Longitudinal Studies; Male; Medical sciences; Middle Aged; Multivariate Analysis; Neoplasms, Second Primary - epidemiology; Neoplasms, Second Primary - pathology; Proportional Hazards Models; Retrospective Studies; Risk Factors; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Tumors
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.08.030

Background A prospective, randomized trial proved that Helicobacter pylori eradication significantly reduces the incidence of metachronous gastric cancer during a 3-year follow-up. Objective To investigate the long-term effect of H pylori eradication on the incidence of metachronous gastric cancer after endoscopic resection of early gastric cancer. Design Retrospective, multicenter study. Setting Kyushu University Hospital and 6 other hospitals in Fukuoka Prefecture, Japan. Patients and Interventions Follow-up data for 268 H pylori –positive patients who had undergone endoscopic resection of early gastric cancer were retrospectively investigated. A total of 177 patients underwent successful H pylori eradication (eradicated group), whereas 91 had persistent H pylori infection (persistent group). Main Outcome Measurements The incidence of metachronous gastric cancer was compared in these 2 groups. Results When the follow-up period was censored at 5 years, the incidence rate in the eradicated group was lower than that observed in the persistent group ( P = .007). During the overall follow-up period ranging from 1.1 to 11.1 years (median 3.0 years), metachronous gastric cancer developed in 13 patients (14.3%) in the persistent group and in 15 patients (8.5%) in the eradicated group ( P = .262, log-rank test). Based on a multivariate logistic regression analysis, baseline severe mucosal atrophy and a follow-up of more than 5 years were found to be independent risk factors for the development of metachronous gastric cancer. Limitations Retrospective study. Conclusions H pylori eradication does not reduce the incidence of metachronous gastric cancer. H pylori eradication should be performed before the progression of gastric mucosal atrophy.