Department of Medicine, University of Hong Kong, Hong Kong.
School of Public Health, University of Hong Kong, Hong Kong.
Gastroenterology. 2018 Jul;155(1):67-75. doi: 10.1053/j.gastro.2018.03.028. Epub 2018 Mar 14.
BACKGROUND & AIMS: Although eradication of Helicobacter pylori infection reduces the risk of gastric cancer, few data are available on its effects in older subjects. We compared the age-specific risk of gastric cancer in a large cohort of subjects who received H pylori eradication therapy vs a matched general population.
We searched the Hospital Authority database of Hong Kong to identify individuals with H pylori infection who had received a course of clarithromycin-containing eradication therapy from January 2003 through December 2012. We compared the gastric cancer incidence in this cohort with the expected incidence for the local general population by retrieving the gastric cancer incidence of the age- and sex-matched population from 2003 through 2014 (the latest available year) from the Hong Kong Cancer Registry. The primary outcome was the incidence of gastric cancer development in the cohort treated for H pylori infection vs the expected number of gastric cancer cases in the general population. Analyses were conducted by a priori age groups of less than 40 years, 40-59 years, and 60 years or older.
Among 73,237 subjects infected with H pylori who received eradication therapy, 200 (0.27%) developed gastric cancer during a median follow-up time of 7.6 years. Compared with the matched general population, the gastric cancer risk was significantly lower in subjects 60 years or older who had received H pylori treatment (standardized incidence ratio [SIR], 0.82; 95% confidence interval [CI], 0.69-0.97; P = .02) but not in younger groups. When data were stratified based on time from H pylori treatment (less than 5 years, 5-9 years, and 10 or more years), the risk of gastric cancer was significantly lower than the general population 10 or more years after eradication in the group 40-59 years old (SIR 0.32; 95% CI, 0.08-0.88; P = .04) and the group 60 years or older (SIR, 0.42; 95% CI, 0.42-0.84; P = .02) than the other age groups.
In an analysis of data from a public hospital database on Hong Kong, we associated treatment of H pylori infection with a lower risk of gastric cancer, particularly in older subjects, 10 or more years after treatment.
尽管根除幽门螺杆菌感染可降低胃癌风险，但针对老年患者的数据有限。我们比较了接受幽门螺杆菌根除治疗的大型队列患者与匹配的一般人群中胃癌的年龄特异性风险。
我们在香港医管局数据库中搜索，以确定在 2003 年 1 月至 2012 年 12 月期间接受克拉霉素含根除治疗的幽门螺杆菌感染患者。我们通过检索香港癌症登记处 2003 年至 2014 年（最新可用年份）与年龄和性别相匹配的人群的胃癌发病率，比较了该队列中幽门螺杆菌感染治疗患者的胃癌发病率与一般人群的预期发病率。主要结果是治疗幽门螺杆菌感染的患者与一般人群中预期胃癌病例数相比，发生胃癌的发生率。通过预先设定的年龄组（小于 40 岁、40-59 岁和 60 岁或以上）进行分析。
在 73237 名接受根除治疗的幽门螺杆菌感染患者中，200 名（0.27%）在中位随访时间为 7.6 年期间发生胃癌。与匹配的一般人群相比，接受幽门螺杆菌治疗的 60 岁或以上患者的胃癌风险显著降低（标准化发病率比[SIR]，0.82；95%置信区间[CI]，0.69-0.97；P=0.02），但在年轻组中则不然。当根据从幽门螺杆菌治疗开始的时间（<5 年、5-9 年和≥10 年）对数据进行分层时，在 40-59 岁和 60 岁或以上的组中，根除后 10 年或以上的胃癌风险显著低于一般人群（SIR 0.32；95%CI，0.08-0.88；P=0.04）和 SIR 0.42（95%CI，0.42-0.84；P=0.02）。
在对香港公立医院数据库数据的分析中，我们发现治疗幽门螺杆菌感染与胃癌风险降低相关，特别是在治疗后 10 年或以上的老年患者中。
