Yanaoka Kimihiko, Oka Masashi, Ohata Hiroshi, Yoshimura Noriko, Deguchi Hisanobu, Mukoubayashi Chizu, Enomoto Shotaro, Inoue Izumi, Iguchi Mikitaka, Maekita Takao, Ueda Kazuki, Utsunomiya Hirotoshi, Tamai Hideyuki, Fujishiro Mitsuhiro, Iwane Masataka, Takeshita Tatsuya, Mohara Osamu, Ichinose Masao
Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama-city, Wakayama, Japan.
Int J Cancer. 2009 Dec 1;125(11):2697-703. doi: 10.1002/ijc.24591.
A longitudinal cohort study was conducted in Helicobactor pylori-infected middle-aged Japanese males to evaluate the preventive effects of H. pylori eradication on the development of gastric cancer according to the extent of chronic atrophic gastritis (CAG). The extent of CAG was monitored by baseline serum pepsinogen (PG) levels. We followed 3,656 subjects with persistent H. pylori infection and 473 subjects with successful H. pylori eradication for cancer development for a mean (SD) of 9.3 (0.7) years. Groups with and without extensive CAG were categorized based on PG test-positive criteria to detect extensive CAG of PG I <or= 70 ng/ml and PG I/II ratio <or= 3.0. During the study period, 5 and 55 gastric cancers developed in H. pylori-eradicated and the noneradicated subjects, respectively, indicating no significant reduction in cancer incidence after H. pylori eradication. Among the noneradicated subjects, 1,329 were PG test-positive and 2,327 were PG test-negative. Gastric cancer was confirmed in 30 and 25 subjects, respectively. Among subjects whose infection was eradicated, 155 were PG test-positive and 318 were PG test-negative. Of these subjects, gastric cancer was confirmed in 3 and 2 subjects, respectively. Significant reduction in cancer incidence after eradication was observed only in PG test-negative subjects (p < 0.05; log-rank test). The results of this study strongly indicate that cancer development after eradication depends on the presence of extensive CAG before eradication and that H. pylori eradication is beneficial to most PG test-negative subjects with mild CAG as defined by the aforementioned criteria.
对感染幽门螺杆菌的日本中年男性进行了一项纵向队列研究，以根据慢性萎缩性胃炎（CAG）的程度评估根除幽门螺杆菌对胃癌发生的预防作用。通过基线血清胃蛋白酶原（PG）水平监测CAG的程度。我们对3656名持续感染幽门螺杆菌的受试者和473名成功根除幽门螺杆菌的受试者进行了平均（标准差）9.3（0.7）年的癌症发生随访。根据PG检测阳性标准对有和无广泛CAG的组进行分类，以检测PG I≤70 ng/ml和PG I/II比值≤3.0的广泛CAG。在研究期间，根除幽门螺杆菌组和未根除组分别有5例和55例发生胃癌，这表明根除幽门螺杆菌后癌症发病率没有显著降低。在未根除的受试者中，1329例PG检测阳性，2327例PG检测阴性。分别有30例和25例确诊为胃癌。在根除感染的受试者中，155例PG检测阳性，318例PG检测阴性。在这些受试者中，分别有3例和2例确诊为胃癌。仅在PG检测阴性的受试者中观察到根除后癌症发病率显著降低（p<0.05；对数秩检验）。这项研究的结果强烈表明，根除后癌症的发生取决于根除前是否存在广泛的CAG，并且根除幽门螺杆菌对大多数符合上述标准的轻度CAG的PG检测阴性受试者有益。
