Masuda Gotaro, Tokunaga Akira, Shirakawa Takashi, Togashi Akiyoshi, Kiyama Teruo, Kato Shunji, Matsukura Norio, Bou Hideki, Watanabe Masanori, Tajiri Takashi
Surgery for Organ and Biological Regulation, First Department of Surgery, Nippon Medical School, Tokyo, Japan.
Gastric Cancer. 2007;10(2):98-103. doi: 10.1007/s10120-007-0414-y. Epub 2007 Jun 25.
Gastric cancers in young adults are thought to be associated with risk factors that include Helicobacter pylori infection and genetic polymorphism. The objective of this study was to elucidate the roles of these risk factors in patients younger than 40 years by analyzing clinicopathological data and H. pylori infection, and using molecular epidemiologic techniques.
Clinicopathological features, the presence of H. pylori infection, endoscopic characteristics of gastritis, genetic polymorphism of P4502E1 (CYP2E1), and family history of cancer in patients with gastric cancer treated surgically at Nippon Medical School Hospital from 1991 to 2004 were analyzed, based on our medical database.
Gastric cancer in those younger than 40 years was characterized by a predominance of female patients with poorly differentiated adenocarcinoma who had undergone total gastrectomy with extended lymphadenectomy. H. pylori infection had a higher prevalence in patients with gastric cancer than in patients with normal endoscopic results or chronic gastritis, especially in those younger than 40 years (odds ratio, 13.7). Atrophic gastritis, nodular gastritis, and rugal hyperplastic gastritis were observed by endoscopy as H. pylori-associated gastritis. No difference in the incidence of either CYP2E1 genetic polymorphism or a family history of cancer was observed among different age groups.
Gastric cancer in patients younger than 40 years is closely associated with H. pylori infection, but not with genetic characteristics. Eradication therapy for H. pylori and endoscopic examination of H. pylori-positive young adults may be anticipated to be adopted as a strategy for the prevention and/or early detection of cancer.
年轻成人胃癌被认为与包括幽门螺杆菌感染和基因多态性在内的危险因素相关。本研究的目的是通过分析临床病理数据和幽门螺杆菌感染情况，并运用分子流行病学技术，阐明这些危险因素在40岁以下患者中的作用。
基于我们的医学数据库，分析了1991年至2004年在日本医科大学医院接受手术治疗的胃癌患者的临床病理特征、幽门螺杆菌感染情况、胃炎的内镜特征、细胞色素P4502E1（CYP2E1）基因多态性以及癌症家族史。
40岁以下的胃癌患者以女性为主，多为低分化腺癌，接受了全胃切除及扩大淋巴结清扫术。胃癌患者中幽门螺杆菌感染的患病率高于内镜检查结果正常或患有慢性胃炎的患者，尤其是在40岁以下的患者中（优势比为13.7）。内镜检查发现萎缩性胃炎、结节性胃炎和皱襞增生性胃炎为幽门螺杆菌相关性胃炎。不同年龄组之间CYP2E1基因多态性或癌症家族史的发生率没有差异。
40岁以下患者的胃癌与幽门螺杆菌感染密切相关，但与遗传特征无关。对幽门螺杆菌进行根除治疗以及对幽门螺杆菌阳性的年轻成人进行内镜检查有望成为预防和/或早期发现癌症的策略。
