Søgaard Kirstine K, Farkas Dóra K, Pedersen Lars, Lund Jennifer L, Thomsen Reimar W, Sørensen Henrik T
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
Cancer Med. 2016 Jun;5(6):1341-51. doi: 10.1002/cam4.680. Epub 2016 Feb 29.
Peptic ulcer predicts gastric cancer. It is controversial if peptic ulcers predict other gastrointestinal cancers, potentially related to Helicobacter pylori or shared lifestyle factors. We hypothesized that gastric and duodenal ulcers may have different impact on the risk of gastrointestinal cancers. In a nationwide cohort study using Danish medical databases 1994-2013, we quantified the risk of gastric and other gastrointestinal cancers among patients with duodenal ulcers (dominantly H. pylori-related) and gastric ulcers (dominantly lifestyle-related) compared with the general population. We started follow-up 1-year after ulcer diagnosis to avoid detection bias and calculated absolute risks of cancer and standardized incidence ratios (SIRs). We identified 54,565 patients with gastric ulcers and 38,576 patients with duodenal ulcers. Patient characteristics were similar in the two cohorts. The 1-5-year risk of any gastrointestinal cancer was slightly higher for gastric ulcers patients (2.1%) than for duodenal ulcers patients (2.0%), and SIRs were 1.38 (95% CI: 1.31-1.44) and 1.30 (95% CI: 1.23-1.37), respectively. The SIR of gastric cancer was higher among patients with gastric ulcer than duodenal ulcer (1.92 vs. 1.38), while the SIRs for other gastrointestinal cancers were similar (1.33 vs. 1.29). Compared with gastric ulcer patients, duodenal ulcer patients were at lower risk of smoking- and alcohol-related gastrointestinal cancers. The risk of nongastric gastrointestinal cancers is increased both for patients with gastric ulcers and with duodenal ulcers, but absolute risks are low. H. pylori may be less important for the development of nongastric gastrointestinal cancer than hypothesized.
消化性溃疡可预测胃癌。消化性溃疡是否能预测其他胃肠道癌症存在争议，这可能与幽门螺杆菌或共同的生活方式因素有关。我们假设胃溃疡和十二指肠溃疡对胃肠道癌症风险可能有不同影响。在一项利用1994年至2013年丹麦医学数据库的全国性队列研究中，我们量化了十二指肠溃疡（主要与幽门螺杆菌相关）和胃溃疡（主要与生活方式相关）患者相较于普通人群患胃癌及其他胃肠道癌症的风险。我们在溃疡诊断后1年开始随访以避免检测偏倚，并计算癌症的绝对风险和标准化发病率比（SIR）。我们识别出54565例胃溃疡患者和38576例十二指肠溃疡患者。两个队列的患者特征相似。胃溃疡患者发生任何胃肠道癌症的1至5年风险（2.1%）略高于十二指肠溃疡患者（2.0%），SIR分别为1.38（95%CI：1.31 - 1.44）和1.30（95%CI：1.23 - 1.37）。胃溃疡患者的胃癌SIR高于十二指肠溃疡患者（1.92对1.38），而其他胃肠道癌症的SIR相似（1.33对1.29）。与胃溃疡患者相比，十二指肠溃疡患者患与吸烟和饮酒相关的胃肠道癌症的风险较低。胃溃疡和十二指肠溃疡患者发生非胃癌性胃肠道癌症的风险均增加，但绝对风险较低。幽门螺杆菌在非胃癌性胃肠道癌症发生中的重要性可能比假设的要低。
