Bahmanyar Shahram, Ye Weimin, Dickman Paul W, Nyrén Olof
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Am J Gastroenterol. 2007 Jun;102(6):1185-91. doi: 10.1111/j.1572-0241.2007.01161.x. Epub 2007 Apr 13.
We aimed to investigate whether the elevated risk of gastric cancer among patients with gastric ulcer (GU) and the enigmatic low risk among patients with duodenal ulcer (DU) pertain to both cardia and noncardia cancer. We also studied the risks among operated patients while taking the disparate baseline risks into consideration.
Retrospective cohorts of 59,550 and 79,412 unoperated patients with DU and GU, respectively, plus 12,840 patients with partial gastric resection and 8,105 with vagotomy, recorded in the Swedish Inpatient Register since 1970, were followed from the first hospitalization (date of operation for the surgery cohort) until occurrence of any cancer, death, emigration, definitive surgery, or December 31, 2003. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) expressed relative risk (RR), compared to the age-, sex-, and calendar period-matched Swedish population. Cox regression produced adjusted RR estimates among operated patients, relative to unoperated ones with the same ulcer type.
While unoperated DU patients had a halved risk of noncardia cancer (SIR=0.5, 95% CI 0.4-0.7), their risk of cardia cancer was slightly above expectation (SIR=1.2, 95% CI 0.8-1.7). Unoperated GU patients had doubled risks for both cancers (SIR=2.1, 95% CI 2.0-2.4 and SIR=1.9, 95% CI 1.4-2.3, respectively). DU patients who underwent gastric resection had a 60% risk elevation (RR=1.6, 95% CI 1.0-2.5) compared to unoperated ones. Vagotomy was associated with a greater risk in the first 10 yr, but this excess disappeared with further follow-up. Resected GU patients had a 40% risk reduction relative to their unoperated peers (RR=0.6, 95% CI 0.5-0.8). This reduction persisted well beyond the first postoperative decade.
The DU-related protection against gastric cancer does not seem to pertain to cardia cancer. With gastric resection, risks are shifted toward normality, regardless of underlying ulcer type.
我们旨在研究胃溃疡（GU）患者患胃癌风险升高以及十二指肠溃疡（DU）患者风险低得出奇是否与贲门癌和非贲门癌均相关。我们还研究了手术患者的风险，并考虑到不同的基线风险。
自1970年起记录在瑞典住院患者登记册中的分别为59550例未手术的DU患者和79412例未手术的GU患者的回顾性队列，外加12840例接受部分胃切除术的患者和8105例接受迷走神经切断术的患者，从首次住院（手术队列的手术日期）开始随访，直至发生任何癌症、死亡、移民、确定性手术或2003年12月31日。标准化发病比（SIRs）及其95%置信区间（CIs）表示相对风险（RR），与年龄、性别和日历期匹配的瑞典人群相比。Cox回归得出手术患者相对于具有相同溃疡类型的未手术患者的调整后RR估计值。
未手术的DU患者患非贲门癌的风险减半（SIR = 0.5，95% CI 0.4 - 0.7），但他们患贲门癌的风险略高于预期（SIR = 1.2，95% CI 0.8 - 1.7）。未手术的GU患者患这两种癌症的风险均增加了一倍（SIR分别为2.1，95% CI 2.0 - 2.4和SIR为1.9，95% CI 1.4 - 2.3）。与未手术的DU患者相比，接受胃切除术的DU患者风险升高了60%（RR = 1.6，95% CI 1.0 - 2.5）。迷走神经切断术在最初10年与更高的风险相关，但随着进一步随访，这种风险增加消失了。与未手术的GU患者相比，接受胃切除术的GU患者风险降低了40%（RR = 0.6，95% CI 0.5 - 0.8）。这种降低在术后第一个十年之后仍持续存在。
与DU相关的对胃癌的保护作用似乎不适用于贲门癌。通过胃切除术，风险趋向正常，无论潜在的溃疡类型如何。
