Mori Genki, Nakajima Takeshi, Asada Kiyoshi, Shimazu Taichi, Yamamichi Nobutake, Maekita Takao, Yokoi Chizu, Fujishiro Mitsuhiro, Gotoda Takuji, Ichinose Masao, Ushijima Toshikazu, Oda Ichiro
Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan.
Gastric Cancer. 2016 Jul;19(3):911-8. doi: 10.1007/s10120-015-0544-6. Epub 2015 Sep 29.
A previous multicenter prospective randomized study from Japan showed that Helicobacter pylori eradication reduced the development of metachronous gastric cancer (MGC) after endoscopic resection for early gastric cancer. MGC risk, however, is not eliminated; yet few studies have evaluated its long-term incidence and risk factors. In this study, we investigated the incidence of and risk factors for MGC in patients who underwent endoscopic resection for early gastric cancer with successful H. pylori eradication.
A total of 594 patients who underwent endoscopic resection for early gastric cancer and successful H. pylori eradication at three institutions (National Cancer Center Hospital, University of Tokyo Hospital, and Wakayama Medical University Hospital) were analyzed retrospectively. Annual endoscopic surveillance was performed after initial endoscopic resection. MGC was defined as a gastric cancer newly detected at least 1 year after successful H. pylori eradication.
Ninety-four MGCs were detected in 79 patients during the 4.5-year median follow-up period. Kaplan-Meier analysis showed the cumulative incidence of MGC 5 years after successful H. pylori eradication was 15.0 %; the incidence of MGC calculated by use of the person-year method was 29.9 cases per 1000 person-years. Multivariate analysis using the Cox proportional hazards model revealed that male sex, severe gastric mucosal atrophy, and multiple gastric cancers before successful H. pylori eradication were independent risk factors for MGC. Eleven percent of MGCs (10 of 94) were detected more than 5 years after successful H. pylori eradication.
Surveillance endoscopy for MGC in patients who have undergone endoscopic resection for early gastric cancer should be performed even after successful H. pylori eradication.
日本之前的一项多中心前瞻性随机研究表明，幽门螺杆菌根除可降低早期胃癌内镜切除术后异时性胃癌（MGC）的发生。然而，MGC风险并未消除；但很少有研究评估其长期发病率和危险因素。在本研究中，我们调查了成功根除幽门螺杆菌的早期胃癌内镜切除患者中MGC的发病率及危险因素。
回顾性分析了在三个机构（国立癌症中心医院、东京大学医院和和歌山县立医科大学医院）接受早期胃癌内镜切除且成功根除幽门螺杆菌的594例患者。初次内镜切除后进行年度内镜监测。MGC定义为在成功根除幽门螺杆菌至少1年后新发现的胃癌。
在4.5年的中位随访期内，79例患者中检测到94例MGC。Kaplan-Meier分析显示，成功根除幽门螺杆菌5年后MGC的累积发病率为15.0%；用人年法计算的MGC发病率为每1000人年29.9例。使用Cox比例风险模型进行的多因素分析显示，男性、严重胃黏膜萎缩以及成功根除幽门螺杆菌前存在多发胃癌是MGC的独立危险因素。11%的MGC（94例中的10例）在成功根除幽门螺杆菌5年多后被检测到。
即使成功根除幽门螺杆菌，对接受早期胃癌内镜切除的患者也应进行MGC监测内镜检查。
