Zhao Bochao, Zhang Jiale, Mei Di, Luo Rui, Lu Huiwen, Xu Huimian, Huang Baojun
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Heping District, Shenyang, P.R. China.
J Clin Gastroenterol. 2020 Mar;54(3):235-241. doi: 10.1097/MCG.0000000000001195.
Whether Helicobacter pylori eradication could reduce the risk of metachronous gastric cancer remain controversial. In the present study, we performed a systematic review and meta-analysis to evaluate the preventive effect of H. pylori eradication on the occurrence of metachronous gastric cancer after curative endoscopic resection of early gastric cancer.
The related studies were identified by searching PubMed and Embase databases. According to the H. pylori infection status and subsequent treatment, all patients were classified into H. pylori negative group, H. pylori eradication group and noneradication group. The relevant data were extracted and pooled effect size was assessed using a fixed effect model or a random effect model.
A total of 11 retrospective cohort studies and 3 randomized controlled trials were included in this meta-analysis. The results based on the cohort studies indicated that the risk of metachronous gastric cancer was significantly lower in H. pylori eradication group than in noneradication group (hazard ratios: 0.65, 95% confidence interval: 0.50-0.86, P=0.002; I=0%). The pooled result of 2 randomized controlled trials demonstrated that the patients receiving anti-H. pylori treatment had a lower risk of metachronous gastric cancer than those who did not receive H. pylori eradication treatment (hazard ratios: 0.43, 95% confidence interval: 0.26-0.70, P=0.001; I=0%). In addition, the occurrence of metachronous gastric cancer in H. pylori eradication group was not significantly different from that in H. pylori negative group.
Successful H. pylori eradication may be useful for the prevention of metachronous gastric cancer after curative endoscopic resection of early gastric cancer. Thus, anti-H. pylori treatment should be considered for those patients with H. pylori infection after curative endoscopic resection.
幽门螺杆菌根除是否能降低异时性胃癌的风险仍存在争议。在本研究中，我们进行了一项系统评价和荟萃分析，以评估根除幽门螺杆菌对早期胃癌内镜根治性切除术后异时性胃癌发生的预防作用。
通过检索PubMed和Embase数据库确定相关研究。根据幽门螺杆菌感染状况及后续治疗，将所有患者分为幽门螺杆菌阴性组、幽门螺杆菌根除组和未根除组。提取相关数据，并使用固定效应模型或随机效应模型评估合并效应量。
本荟萃分析共纳入11项回顾性队列研究和3项随机对照试验。基于队列研究的结果表明，幽门螺杆菌根除组异时性胃癌的风险显著低于未根除组（风险比：0.65，95%置信区间：0.50 - 0.86，P = 0.002；I² = 0%）。2项随机对照试验的汇总结果显示，接受抗幽门螺杆菌治疗的患者发生异时性胃癌的风险低于未接受幽门螺杆菌根除治疗的患者（风险比：0.43，95%置信区间：0.26 - 0.70，P = 0.001；I² = 0%）。此外，幽门螺杆菌根除组异时性胃癌的发生率与幽门螺杆菌阴性组无显著差异。
成功根除幽门螺杆菌可能有助于预防早期胃癌内镜根治性切除术后的异时性胃癌。因此，对于内镜根治性切除术后幽门螺杆菌感染的患者，应考虑进行抗幽门螺杆菌治疗。
