Terasawa Teruhiko, Hamashima Chisato, Kato Katsuaki, Miyashiro Isao, Yoshikawa Takaki, Takaku Reo, Nishida Hiroshi
Emergency and General Internal Medicine, Fujita Health University, Toyoake, Japan
Department of Nursing, Faculty of Medical Technology, Teikyo University, Tokyo, Japan.
BMJ Open. 2019 Sep 20;9(9):e026002. doi: 10.1136/bmjopen-2018-026002.
Recent meta-analyses of eradication therapy in -infected adults reported significant reductions in gastric carcinoma risk. However, concerns about supporting unfocused screening and eradication programme in healthy, asymptomatic populations have arisen. We performed a systematic review and Bayesian meta-analysis to provide an accurate interpretation of randomised evidence on the preventive effectiveness of eradication therapy on gastric carcinoma risk.
We searched databases including PubMed, Cochrane Central and Embase for reference and citation tracking without language restrictions, from inception through 31 July 2018. Paired investigators independently selected randomised controlled trials (RCTs) comparing eradication therapy with placebo or no treatment for asymptomatic or dyspeptic -infected adults with no previous gastric carcinoma. The main outcome was gastric carcinoma incidence; secondary outcomes included gastric carcinoma-specific, non-gastric carcinoma and all-cause mortality.
A total of 5 population-based and 2 outpatient care-based RCTs involving 7303 adults were eligible. Eradication algorithms were heterogeneous, and unsuccessful eradication and reinfection were frequently observed. A Bayesian meta-analysis with competing risk outcomes found low-certainty evidence that eradication therapy might be more likely than control to reduce gastric carcinoma risk (HR=0.65; 95% credible interval (CrI) 0.41 to 1.0; =11%). The CrIs included the null effects across the subgroup and sensitivity analyses, apart from those based on particular models that excluded two RCTs that enrolled subjects with specific histological findings only (HR=0.55; CrI 0.30 to 0.89; =14%). The uncertainty of the average 41% risk reduction in gastric carcinoma-specific mortality included a clinically important mortality risk increase (HR=0.59 favouring eradication therapy; CrI 0.25 to 1.20; =13%; low certainty).
There is insufficient evidence to support or refute the effectiveness of eradication therapy in preventing gastric carcinoma in -infected, high-risk populations. Rigorously conducted large RCTs of healthy infected adults only would provide evidence of the true efficacy of successful eradication. CRD42014009245.
近期对幽门螺杆菌感染成人根除治疗的荟萃分析报告显示，胃癌风险显著降低。然而，对于在健康无症状人群中支持无针对性的筛查和根除计划，人们产生了担忧。我们进行了一项系统评价和贝叶斯荟萃分析，以准确解读关于根除治疗对胃癌风险预防效果的随机证据。
我们检索了包括PubMed、Cochrane Central和Embase在内的数据库，进行参考文献和引文追踪，无语言限制，从数据库建立至2018年7月31日。由两名研究人员独立选择随机对照试验（RCT），比较根除治疗与安慰剂或不治疗，对象为无症状或有消化不良症状的幽门螺杆菌感染成人，且既往无胃癌。主要结局为胃癌发病率；次要结局包括胃癌特异性、非胃癌和全因死亡率。
共有5项基于人群和2项基于门诊护理的RCT符合条件，涉及7303名成人。根除方案各异，且经常观察到根除失败和再感染情况。一项具有竞争风险结局的贝叶斯荟萃分析发现，低确定性证据表明，根除治疗可能比对照更有可能降低胃癌风险（风险比[HR]=0.65；95%可信区间[CrI]0.41至1.0；P=11%）。除了基于特定模型排除仅纳入具有特定组织学结果受试者的两项RCT的分析外，亚组分析和敏感性分析的CrI均包含无效效应（HR=0.55；CrI 0.30至0.89；P=14%）。胃癌特异性死亡率平均降低41%的不确定性包括临床上重要的死亡风险增加（HR=0.59支持根除治疗；CrI 0.25至1.20；P=13%；低确定性）。
没有足够证据支持或反驳根除治疗在预防幽门螺杆菌感染高危人群胃癌方面的有效性。仅对健康感染成人进行严格实施的大型RCT将提供成功根除真正疗效的证据。CRD42014009245。
