Characteristics of Primary and Metachronous Gastric Cancers Discovered after Helicobacter pylori Eradication: A Multicenter Propensity Score-Matched Study
2
조회
0
다운로드
5
인용
0
참고문헌
키워드
초록
Background/Aims: Gastric cancers develop even after successful Helicobacter pylori eradication. We aimed to clarify the characteristics of early gastric cancers discovered after H. pylori eradication. Methods: A total of 1,053 patients with early gastric cancer treated by endoscopic submucosal dissection were included. After matching the propensity score, we retrospectively investigated the clinicopathological features of 192 patients, including 96 patients who had undergone successful H. pylori eradication (Hp-eradicated group) and 96 patients who had active H. pylori infection (Hp-positive group). Results: In the Hp-eradicated group, early gastric cancers were discovered 1 to 15 years (median, 4.1 years) after H. pylori eradication. Compared with Hp-positive patients, Hp-eradicated patients showed a more frequently depressed configuration (81% vs 53%, respectively, p<0.0001) and a higher trend toward submucosal invasion (18% vs 8%, respectively, p=0.051). A multivariable analysis revealed the macroscopic depressed type to be characteristics of early gastric cancers after H. pylori eradication. Among patients in the Hp-eradicated group, metachronous cancers showed less frequent depressed lesions (68% vs 84%, respectively, p=0.049) and smaller tumor sizes (median, 11 mm vs 14 mm, respectively, p=0.014) than primary cancers. Conclusions: Early gastric cancers after H. pylori eradication are characterized by a depressed configuration. Careful follow-up endoscopies are necessary after H. pylori eradication.
Abstract
Background/Aims: Gastric cancers develop even after successful Helicobacter pylori eradication. We aimed to clarify the characteristics of early gastric cancers discovered after H. pylori eradication. Methods: A total of 1,053 patients with early gastric cancer treated by endoscopic submucosal dissection were included. After matching the propensity score, we retrospectively investigated the clinicopathological features of 192 patients, including 96 patients who had undergone successful H. pylori eradication (Hp-eradicated group) and 96 patients who had active H. pylori infection (Hp-positive group). Results: In the Hp-eradicated group, early gastric cancers were discovered 1 to 15 years (median, 4.1 years) after H. pylori eradication. Compared with Hp-positive patients, Hp-eradicated patients showed a more frequently depressed configuration (81% vs 53%, respectively, p<0.0001) and a higher trend toward submucosal invasion (18% vs 8%, respectively, p=0.051). A multivariable analysis revealed the macroscopic depressed type to be characteristics of early gastric cancers after H. pylori eradication. Among patients in the Hp-eradicated group, metachronous cancers showed less frequent depressed lesions (68% vs 84%, respectively, p=0.049) and smaller tumor sizes (median, 11 mm vs 14 mm, respectively, p=0.014) than primary cancers. Conclusions: Early gastric cancers after H. pylori eradication are characterized by a depressed configuration. Careful follow-up endoscopies are necessary after H. pylori eradication.
참고문헌 (26)
- Fock KM, "Review article: the epidemiology and prevention of gastric cancer", Aliment Pharmacol Ther, 40, pp.250~260 (2014)
- Yamagata H, "Impact of Helicobacter pylori infection on gastric cancer incidence in a general Japanese population: the Hisayama study", Arch Intern Med, 160, pp.1962~1968 (2000)
- Uemura N, "Helicobacter pylori infection and the development of gastric cancer", N Engl J Med, 345, pp.784~789 (2001)
- International Agency for Research on Cancer, "World Health Organization. Schistosomes, liver flukes and Helicobacter pylori", IARC Monogr Eval Carcinog Risks Hum, 61, pp.177~241 (1994)
- 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)
- Maehata Y, "Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer", Gastrointest Endosc, 75, pp.39~46 (2012)
- Seo JY, "Eradication of Helicobacter pylori reduces metachronous gastric cancer after endoscopic resection of early gastric cance", Hepatogastroenterology, 60, pp.776~780 (2013)
- Choi J, "Eradication of Helicobacter pylori after endoscopic resection of gastric tumors does not reduce incidence of metachronous gastric carcinoma", Clin Gastroenterol Hepatol, 12, pp.793~800.e1 (2014)
- Bae SE, "Effect of Helicobacter pylori eradication on metachronous recurrence after endoscopic resection of gastric neoplasm", Am J Gastroenterol, 109, pp.60~67 (2014)
- Kwon YH, "Failure of Helicobacter pylori eradication and age are independent risk factors for recurrent neoplasia after endoscopic resection of early gastric cancer in 283 patients", Aliment Pharmacol Ther, 39, pp.609~618 (2014)
- Yoon SB, "Effect of Helicobacter pylori eradication on metachronous gastric cancer after endoscopic resection of gastric tumors: a meta-analysis", Helicobacter, 19, pp.243~248 (2014)
- Gotoda T, "Endoscopic submucosal dissection of early gastric cancer", J Gastroenterol, 41, pp.929~942 (2006)
- Austin PC, "Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score", Am J Epidemiol, 172, pp.1092~1097 (2010)
- Japanese Gastric Cancer Association, "Japanese classification of gastric carcinoma: 3rd English edition", Gastric Cancer, 14, pp.101~112 (2011)
- Participants in the Paris Workshop, "The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002", Gastrointest Endosc, 58(6 Suppl), pp.S3~S43 (2003)
- Kamada T, "Clinical features of gastric cancer discovered after successful eradication of Helicobacter pylori: results from a 9-year prospective follow-up study in Japan", Aliment Pharmacol Ther, 21, pp.1121~1126 (2005)
- Mabe K, "Does Helicobacter pylori eradication therapy for peptic ulcer prevent gastric cancer", World J Gastroenterol, 15, pp.4290~4297 (2009)
- Take S, "The long-term risk of gastric cancer after the successful eradication of Helicobacter pylori", J Gastroenterol, 46, pp.318~324 (2011)
- Yamamoto K, "Clinicopathological analysis of early-stage gastric cancers detected after successful eradication of Helicobacter pylori", Helicobacter, 16, pp.210~216 (2011)
- Matsuo T, "Gastric cancer development after Helicobacter pylori eradication therapy: a new form of gastric neoplasia", Digestion, 85, pp.61~67 (2012)
- Ito M, "Morphological changes in human gastric tumours after eradication therapy of Helicobacter pylori in a short-term follow-up", Aliment Pharmacol Ther, 21, pp.559~566 (2005)
- Asaka M, "Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition", Helicobacter, 15, pp.1~20 (2010)
- Kim SG, "Guidelines for the diagnosis and treatment of Helicobacter pylori infection in Korea, 2013 revised edition", J Gastroenterol Hepatol, 29, pp.1371~1386 (2014)
- Mori G, "Incidence of and risk factors for metachronous gastric cancer after endoscopic resection and successful Helicobacter pylori eradication: results of a large-scale, multicenter cohort study in Japan", Gastric Cancer, 19, pp.911~918 (2016)
- Kato M, "Eradication of Helicobacter pylori for primary gastric cancer and secondary gastric cancer after endoscopic mucosal resection.", J Gastroenterol, 42(Suppl 17), pp.16~20 (2007)
- Kobayashi M, "Magnifying narrow-band imaging of surface maturation in early differentiated-type gastric cancers after Helicobacter pylori eradication", J Gastroenterol, 48, pp.1332~1342 (2013)