Division of Endoscopy, Department of Cancer Screening Center, Cancer Institute Hospital, Tokyo, Japan; Jiyugaoka Gastroenterology and Endoscopy Clinic, Tokyo, Japan.
Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Gastrointest Endosc. 2019 Jun;89(6):1152-1159.e1. doi: 10.1016/j.gie.2019.02.026. Epub 2019 Feb 27.
The incidence of metachronous gastric cancer (MGC) in patients whose primary gastric neoplasm is discovered after Helicobacter pylori eradication remains unclear. Here, we evaluated the long-term effect of previous H pylori eradication on development of MGC after endoscopic submucosal dissection (ESD).
We analyzed prospectively collected data of consecutive patients with successful H pylori eradication more than 1 year before (eradicated group, 180 patients) or after (control group, 602 patients) initial curative ESD. These patients were also followed by endoscopy for over 2 years. Propensity score matching and inverse probability of treatment weighting (IPTW) were used to adjust for confounding variables during data analysis. The main outcome was the incidence of MGC after initial ESD.
In a propensity-matched analysis of 174 pairs, the incidence of MGC was similar in the 2 cohorts (33.9 per 1000 person-years vs 40.8 per 1000 person-years in the control group, P = .454) at a median follow-up of 4.1 years (interquartile range, 3.0-5.6). Incidences were also similar in the 2 groups when data were analyzed using IPTW, even after exclusion of 123 patients with successful H pylori eradication <5 years before initial ESD. Multiple Cox regression analysis revealed age, differentiated-type histology, and initial multiplicity were predictors of MGC in patients after initial curative ESD.
The frequency of follow-up surveillance after initial curative ESD should be kept constant, irrespective of whether H pylori eradication is performed before or after initial curative ESD.
在幽门螺杆菌（H. pylori）根除后发现原发性胃肿瘤的患者中，同时性胃癌（MGC）的发生率尚不清楚。在此，我们评估了先前 H. pylori 根除对内镜黏膜下剥离（ESD）后 MGC 发生的长期影响。
我们分析了前瞻性收集的连续患者数据，这些患者在初始根治性 ESD 前（根除组，180 例）或后（对照组，602 例）成功进行 H. pylori 根除超过 1 年，且这些患者还接受了超过 2 年的内镜随访。在数据分析中使用倾向评分匹配和逆概率治疗加权（IPTW）来调整混杂变量。主要结局是初始 ESD 后 MGC 的发生率。
在 174 对的倾向评分匹配分析中，两组的 MGC 发生率相似（对照组为每 1000 人年 33.9 例，对照组为每 1000 人年 40.8 例，P=0.454），中位随访时间为 4.1 年（四分位距，3.0-5.6）。即使在排除了 123 例初次 ESD 前 H. pylori 根除成功<5 年的患者后，使用 IPTW 分析数据时，两组的发生率也相似。多 Cox 回归分析显示，年龄、分化型组织学和初始多发性是初始根治性 ESD 后患者发生 MGC 的预测因素。
无论在初始根治性 ESD 前是否进行 H. pylori 根除，初始根治性 ESD 后随访监测的频率都应保持不变。
