Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland.
Int J Cancer. 2011 Jan 15;128(2):433-9. doi: 10.1002/ijc.25337. Epub 2010 Mar 22.
Helicobacter pylori infection is associated with gastric cancer. A total of 97% of the infected subjects have elevated levels of H. pylori antibodies. The antibody titers have been shown to decline rapidly (40-60% within 4-12 months) only after successful eradication therapy. We allocated 26,700 consecutive patients tested during 1986-1998 for H. pylori antibodies to 3 subcohorts: seropositive patients with rapidly falling antibody titers (Hp+CURED, n = 3,650), seropositive patients where no serological information indicating cure was obtained (Hp+NoInfo, n = 11,638) and seronegative patients (Hp-, n = 11,422). In the subcohorts, the standardised incidence ratios (SIRs) with 95% confidence intervals (CI) were defined for subsequent cancers of stomach, pancreas, colon, rectum, breast and prostate separately and for all cancers except stomach combined. The mean follow-up time was 10.1 years and the number of gastric cancers was 72. For the Hp+CURED, the SIR for gastric cancers for the first 5 follow-up years was 1.62 but decreased from the sixth follow-up year thereon to 0.14 (CI: 0.00-0.75). Likewise, the risk ratio, defined in a Poisson regression analysis using the Hp+NoInfo group as the reference, decreased from 1.60 to 0.13 (CI: 0.02-1.00, p = 0.049). The SIR for Hp- was not significantly higher than that for Hp+NoInfo for any of the cancers analysed. To conclude, cured H. pylori infection led to a significantly decreased incidence of gastric cancers from the sixth follow-up year. Advanced atrophic gastritis would be a plausible contributor to the elevated SIR in elderly Hp- patients.
幽门螺杆菌感染与胃癌有关。感染的受试者中有 97%的人幽门螺杆菌抗体水平升高。已经表明，只有在成功根除治疗后，抗体滴度才会迅速下降（4-12 个月内下降 40-60%）。我们将 1986 年至 1998 年间检测到的 26700 例连续患者的幽门螺杆菌抗体分为 3 个亚组：抗体滴度迅速下降的血清阳性患者（Hp+CURED，n=3650）、未获得任何血清学信息表明治愈的血清阳性患者（Hp+NoInfo，n=11638）和血清阴性患者（Hp-，n=11422）。在这些亚组中，定义了随后胃癌、胰腺癌、结肠癌、直肠癌、乳腺癌和前列腺癌以及除胃癌以外的所有癌症的标准化发病比（SIR）及其 95%置信区间（CI）。平均随访时间为 10.1 年，胃癌病例数为 72 例。对于 Hp+CURED，前 5 年的胃癌 SIR 为 1.62，但从第 6 年开始，该比值下降至 0.14（CI：0.00-0.75）。同样，使用 Hp+NoInfo 组作为参考，在泊松回归分析中定义的风险比从 1.60 下降至 0.13（CI：0.02-1.00，p=0.049）。对于任何分析的癌症，Hp-的 SIR 均未显著高于 Hp+NoInfo。总之，治愈的幽门螺杆菌感染导致从第 6 年开始胃癌的发病率显著下降。晚期萎缩性胃炎可能是老年 Hp-患者 SIR 升高的一个合理因素。
