幽门螺杆菌根除对胃肿瘤内镜切除后异时性复发的影响。
Effect of Helicobacter pylori eradication on metachronous recurrence after endoscopic resection of gastric neoplasm.
机构信息
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea.
Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea.
出版信息
Am J Gastroenterol. 2014 Jan;109(1):60-7. doi: 10.1038/ajg.2013.404. Epub 2013 Dec 17.
OBJECTIVES
Although many epidemiologic studies have shown that Helicobacter pylori (H. pylori) eradication has prophylactic effects on gastric cancer, their results are less clear in high-risk populations. We conducted this study to examine whether H. pylori eradication would affect the occurrence of metachronous gastric cancer after endoscopic resection in patients with early gastric cancer.
METHODS
We retrospectively analyzed 2,089 adults who underwent endoscopic resection of gastric low-grade neoplasia, high-grade neoplasia, or differentiated invasive neoplasia from 2004 to 2008 at Asan Medical Center. Of these, a total of 1,007 patients with early gastric cancer were enrolled in this study. We evaluated the demographic data, the pathology, and the incidence of metachronous recurrence by dividing them into three groups: those without active H. pylori infection (Hp negative group, n=340), those who successfully underwent H. pylori eradication (eradicated group, n=485), and those who failed or did not undergo H. pylori eradication (noneradicated group, n=182).
RESULTS
Metachronous recurrence was diagnosed in 75 patients, including 17 in the Hp, 34 in the eradicated, and 24 in the noneradicated groups. Median time to metachronous recurrence was 18 months (range, 7-75 months). The incidence of metachronous gastric cancer was 10.9 cases per 1,000 person-years in the Hp negative group, 14.7 cases per 1,000 person-years in the eradicated group, and 29.7 cases per 1,000 person-years in the noneradicated group. The hazard ratios in the noneradicated group compared with the Hp negative and eradicated groups were 2.5 (P<0.01) and 1.9 (P=0.02), respectively. H. pylori eradication reduced metachronous recurrence of gastric neoplasm, which was also shown in the secondary analysis of 1,487 patients with low-grade neoplasia and early gastric cancer.
CONCLUSIONS
Successful H. pylori eradication may reduce the occurrence of metachronous gastric cancer after endoscopic resection in patients with early gastric cancer.
目的
尽管许多流行病学研究表明，幽门螺杆菌（H. pylori）根除对胃癌具有预防作用，但在高危人群中的结果并不明确。我们进行这项研究是为了检验在早期胃癌患者内镜切除术后，H. pylori 根除是否会影响其发生异时性胃癌。
方法
我们回顾性分析了 2004 年至 2008 年期间在 Asan 医疗中心接受内镜下胃低级别瘤变、高级别瘤变或分化型侵袭性瘤变切除的 2089 名成年人，其中共有 1007 名早期胃癌患者纳入本研究。我们通过将患者分为三组来评估其人口统计学数据、病理特征和异时性复发发生率：无活动性 H. pylori 感染（Hp 阴性组，n=340）、成功根除 H. pylori（根除组，n=485）和未能根除或未行 H. pylori 根除（未根除组，n=182）。
结果
75 例患者诊断为异时性复发，其中 Hp 阴性组 17 例，根除组 34 例，未根除组 24 例。异时性复发的中位时间为 18 个月（范围，7-75 个月）。Hp 阴性组、根除组和未根除组的异时性胃癌发生率分别为每 1000 人年 10.9 例、每 1000 人年 14.7 例和每 1000 人年 29.7 例。与 Hp 阴性组和根除组相比，未根除组的风险比分别为 2.5（P<0.01）和 1.9（P=0.02）。H. pylori 根除可降低早期胃癌患者内镜切除术后异时性胃肿瘤的复发，在低级别肿瘤和早期胃癌的 1487 名患者的二次分析中也显示了这一点。
结论
成功根除 H. pylori 可能会降低早期胃癌患者内镜切除术后异时性胃癌的发生。
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