Health Promotion Center, Seoul National University Hospital, Seoul, Korea; Yonsei University Graduate School of Medicine, Seoul, Korea.
Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea.
Gastrointest Endosc. 2020 Sep;92(3):613-622.e1. doi: 10.1016/j.gie.2020.05.029. Epub 2020 May 27.
Helicobacter pylori eradication can reduce the risk of metachronous lesions after the treatment of early gastric cancer. We aimed to analyze the impact of the timing of H pylori eradication on metachronous recurrence.
Data of patients who underwent endoscopic resection or partial gastrectomy for early stage gastric cancer and received H pylori eradication therapy were obtained from the Korean National Health Insurance Service database. Patients were classified into 3 groups according to the timing of the prescription for H pylori eradication: preresection; within 1 year postresection; and >1 year postresection.
Among 19,767 patients, 7452 and 12,315 underwent endoscopic resection and surgery, respectively. The 5-year cumulative incidence of metachronous lesions after endoscopic resection was 14.0% in the preresection group, 12.3% in the within 1 year postresection group, and 16.9% in the >1 year postresection group. Surgery was performed in 1.2% of the preresection group, 1.3% of the within 1 year postresection group, and 2.9% of the >1 year postresection group. The within 1 year postresection group had a lower risk of development of metachronous lesions than the >1 year postresection group (hazard ratio [95% confidence interval]: after endoscopic resection, 0.79 [0.65-0.95]; after surgery, 0.39 [0.28-0.53]). The risk of development of metachronous lesions did not differ between the preresection and within 1 year postresection groups.
Prescription of H pylori eradication therapy within 1 year after gastric cancer treatment reduces the risk of development of metachronous gastric neoplasms compared with a late prescription of eradication therapy in patients undergoing endoscopic resection and those undergoing surgery.
根除幽门螺杆菌（H. pylori）可降低早期胃癌治疗后发生异时性病变的风险。本研究旨在分析 H. pylori 根除时机对异时性复发的影响。
从韩国国家健康保险服务数据库中获取了接受内镜切除术或部分胃切除术治疗早期胃癌且接受 H. pylori 根除治疗的患者数据。根据 H. pylori 根除治疗处方的时间，将患者分为 3 组：术前；术后 1 年内；术后>1 年。
在 19767 例患者中，7452 例行内镜切除术，12315 例行手术。术前组内镜切除术后 5 年异时性病变的累积发生率为 14.0%，术后 1 年内组为 12.3%，术后>1 年组为 16.9%。术前组中有 1.2%的患者行手术治疗，术后 1 年内组为 1.3%，术后>1 年组为 2.9%。术后 1 年内组发生异时性病变的风险低于术后>1 年组（风险比[95%置信区间]：内镜切除术后，0.79[0.65-0.95]；手术治疗后，0.39[0.28-0.53]）。术前组和术后 1 年内组发生异时性病变的风险无差异。
与胃癌治疗后延迟根除 H. pylori 相比，在胃癌治疗后 1 年内开具 H. pylori 根除治疗处方可降低内镜切除术和手术治疗患者发生异时性胃肿瘤的风险。
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