Risk Assessment of Metachronous Gastric Neoplasm after Endoscopic Resection for Early Gastric Cancer According to Age at Helicobacter pylori Eradication
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Background/Aims: Helicobacter pylori eradication can reduce the incidence of metachronous gastric neoplasm (MGN) after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). This study evaluated the risk of developing MGN after ESD for EGC based on age at H. pylori eradication. Methods: Data of patients who underwent curative ESD for EGC with H. pylori infection between 2005 and 2018 were retrospectively analyzed. The patients were allocated to four groups according to age at H. pylori eradication: group 1 (<50 years), group 2 (50–59 years), group 3 (60–69 years), and group 4 (≥70 years). Results: All patients were followed up for at least 5 years after ESD. The 5-year cumulative incidence of MGN was 2.1%, 7.0%, 8.7%, and 16.7% in groups 1, 2, 3, and 4, respectively (p<0.001), and groups 3 and 4 showed a significant increase in the risk of MGN (hazard ratio [HR], 4.66; 95% confidence interval [CI], 1.09 to 19.92 and HR, 10.75; 95% CI, 2.45 to 47.12). After adjustments for moderate to severe intestinal metaplasia based on the updated Sydney system, groups 3 and 4 remained significantly associated with MGN (HR, 4.40; 95% CI, 1.03 to 18.84 and HR, 10.14; 95% CI, 2.31 to 44.57). Conclusions: The incidence of MGN after ESD for EGC increased with age at H. pylori eradication. Age at H. pylori eradication ≥60 years was an independent risk factor for MGN, even after adjusting for the presence of advanced intestinal metaplasia.
Abstract
Background/Aims: Helicobacter pylori eradication can reduce the incidence of metachronous gastric neoplasm (MGN) after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). This study evaluated the risk of developing MGN after ESD for EGC based on age at H. pylori eradication. Methods: Data of patients who underwent curative ESD for EGC with H. pylori infection between 2005 and 2018 were retrospectively analyzed. The patients were allocated to four groups according to age at H. pylori eradication: group 1 (<50 years), group 2 (50–59 years), group 3 (60–69 years), and group 4 (≥70 years). Results: All patients were followed up for at least 5 years after ESD. The 5-year cumulative incidence of MGN was 2.1%, 7.0%, 8.7%, and 16.7% in groups 1, 2, 3, and 4, respectively (p<0.001), and groups 3 and 4 showed a significant increase in the risk of MGN (hazard ratio [HR], 4.66; 95% confidence interval [CI], 1.09 to 19.92 and HR, 10.75; 95% CI, 2.45 to 47.12). After adjustments for moderate to severe intestinal metaplasia based on the updated Sydney system, groups 3 and 4 remained significantly associated with MGN (HR, 4.40; 95% CI, 1.03 to 18.84 and HR, 10.14; 95% CI, 2.31 to 44.57). Conclusions: The incidence of MGN after ESD for EGC increased with age at H. pylori eradication. Age at H. pylori eradication ≥60 years was an independent risk factor for MGN, even after adjusting for the presence of advanced intestinal metaplasia.
참고문헌 (33)
- Sung H, "Global Cancer Statistics 2020 : GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries", CA Cancer J Clin, 71, pp.209~249 (2021)
- Kim SG, "Long-term clinical outcomes of endoscopic submucosal dissection in patients with early gastric cancer : a prospective multicenter cohort study", Gut Liver, 12, pp.402~410 (2018)
- Japanese Gastric Cancer Association, "Japanese Gastric Cancer Treatment Guidelines 2021(6th edition)", Gastric Cancer, 26, pp.1~25 (2023)
- Kim SG, "Current status of endoscopic submucosal dissection for early gastric cancer in Korea : role and benefits", Korean J Intern Med, 34, pp.785~793 (2019)
- Lee E, "Metachronous gastric neoplasm beyond 5 years after endoscopic resection for early gastric cancer", Surg Endosc, 37, pp.3901~3910 (2023)
- Ortigão R, "Risk factors for gastric metachronous lesions after endoscopic or surgical resection : a systematic review and meta-analysis", Endoscopy, 54, pp.892~901 (2022)
- Suk S, "The pattern of metachronous recurrence after endoscopic submucosal dissection for gastric adenocarcinoma and dysplasias", Clin Endosc, 56, pp.470~478 (2023)
- Libânio D, "Long-term outcomes of gastric endoscopic submucosal dissection : focus on metachronous and noncurative resection management", GE Port J Gastroenterol, 24, pp.31~39 (2017)
- Boda T, "Characteristics of metachronous gastric tumors after endoscopic submucosal dissection for gastric intraepithelial neoplasms", Gastroenterol Res Pract, 2014, pp.863595~ (2014)
- Lee MW, "Metachronous gastric cancer : another hurdle for successful endoscopic treatment for early gastric cancer?", Gut Liver, 14, pp.145~147 (2020)
- Chung CS, "Risk factors for metachronous recurrence after endoscopic submucosal dissection of early gastric cancer", J Korean Med Sci, 32, pp.421~426 (2017)
- Yang HJ, "Surveillance strategy according to age after endoscopic resection of early gastric cancer", Surg Endosc, 32, pp.846~854 (2018)
- Na YS, "Risk assessment of metachronous gastric cancer development using OLGA and OLGIM systems after endoscopic submucosal dissection for early gastric cancer : a long-term follow-up study", Gastric Cancer, 26, pp.298~306 (2023)
- Yoon H, "Risk factors for metachronous gastric neoplasms in patients who underwent endoscopic resection of a gastric neoplasm", Gut Liver, 10, pp.228~236 (2016)
- Shin GY, "Increased incidence of metachronous gastric neoplasm after endoscopic resection in patients with synchronous gastric neoplasm", BMC Gastroenterol, 20, pp.206~ (2020)
- Bang CS, "Helicobacter pylori eradication for prevention of metachronous recurrence after endoscopic resection of early gastric cancer", J Korean Med Sci, 30, pp.749~756 (2015)
- Zhao B, "Does Helicobacter pylori eradication reduce the incidence of metachronous gastric cancer after curative endoscopic resection of early gastric cancer : a systematic review and meta-analysis", J Clin Gastroenterol, 54, pp.235~241 (2020)
- Choi IJ, "Helicobacter pylori therapy for the prevention of metachronous gastric cancer", N Engl J Med, 378, pp.1085~1095 (2018)
- Fukase K, "Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer : an open-label, randomized controlled trial", Lancet, 372, pp.392~397 (2008)
- Choi JM, "Effects of Helicobacter pylori eradication for metachronous gastric cancer prevention : a randomized controlled trial", Gastrointest Endosc, 88, pp.475~485 (2018)
- Correa P, "Helicobacter pylori and gastric carcinogenesis", Am J Surg Pathol, 19(Suppl 1), pp.S37~S43 (1995)
- Japanese Gastric Cancer Association, "Japanese classification of gastric carcinoma : 3rd English edition", Gastric Cancer, 14, pp.101~112 (2011)
- Dixon MF, "Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994", Am J Surg Pathol, 20, pp.1161~1181 (1996)
- Abe S, "Long-term surveillance and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection", Endoscopy, 47, pp.1113~1118 (2015)
- Han SJ, "Long-term effects of Helicobacter pylori eradication on metachronous gastric cancer development", Gut Liver, 12, pp.133~141 (2018)
- Huang KK, "Genomic and epigenomic profiling of high-risk intestinal metaplasia reveals molecular determinants of progression to gastric cancer", Cancer Cell, 33, pp.137~150 (2018)
- Shichijo S, "Histologic intestinal metaplasia and endoscopic atrophy are predictors of gastric cancer development after Helicobacter pylori eradication", Gastrointest Endosc, 84, pp.618~624 (2016)
- Wong BC, "Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China : a randomized controlled trial", JAMA, 291, pp.187~194 (2004)
- Leung WK, "Factors predicting progression of gastric intestinal metaplasia : results of a randomized trial on Helicobacter pylori eradication", Gut, 53, pp.1244~1249 (2004)
- Watari J, "Preventing metachronous gastric cancer after the endoscopic resection of gastric epithelial neoplasia : roles of Helicobacter pylori eradication and aspirin", Gut Liver, 14, pp.281~290 (2020)
- Choi JM, "Helicobacter pylori eradication can reverse the methylation-associated regulation of miR-200a", b in gastric carcinogenesis, 2020, pp.14, 571~580
- Chen HN, "Helicobacter pylori eradication cannot reduce the risk of gastric cancer in patients with intestinal metaplasia and dysplasia : evidence from a meta-analysis", Gastric Cancer, 19, pp.166~175 (2016)
- Rokkas T, "A systematic review and meta-analysis of the role of Helicobacter pylori eradication in preventing gastric cancer", Ann Gastroenterol, 30, pp.414~423 (2017)