Department of Medicine II, University Hospital, LMU Munich, Munich, Germany, Marchioninistr. 15, 81377, Munich, Germany.
Best Pract Res Clin Gastroenterol. 2021 Mar-Apr;50-51:101741. doi: 10.1016/j.bpg.2021.101741. Epub 2021 Mar 16.
Gastric cancer is the fifth leading cancer worldwide. Infection with Helicobacter pylori represents the major risk factor, but only a small fraction of infected individuals will develop neoplasia. The progression of advanced gastric lesions to cancer is influenced by characteristics of the bacterial strain, host genetic and environmental factors. Recently, the effect of medications on gastric cancer risk has gained interest, because many commonly prescribed drugs affect gastric homeostasis. While non-steroidal anti-inflammatory drugs (NSAIDs) are a frequent cause of gastric ulcer disease, low-dose aspirin has been propagated for chemoprevention of various tumour entities. Beneficial effects of cyclooxygenase-inhibition for gastric cancer prevention is plausible, but its clinical relevance remains unclear. Furthermore, anti-tumorous effects have been postulated for statins and metformin. On the contrary, proton pump inhibitors (PPIs), which are commonly used for prevention of gastric ulcers and bleeding, have been associated with an increased gastric cancer risk in large observational studies. Most of these observations still require confirmation in prospective controlled trials. NSAIDs, statins and metformin have also been investigated as concomitant cancer treatment, but studies did not show convincing results to date. Here, we review the available evidence and possible mechanisms for the role of PPIs, NSAIDs, statins and metformin in gastric carcinogenesis, and discuss possible implications for clinical practice.
胃癌是全球第五大常见癌症。感染幽门螺杆菌是主要的风险因素，但只有一小部分感染者会发展为肿瘤。高级胃病变发展为癌症的过程受到细菌菌株、宿主遗传和环境因素的影响。最近，药物对胃癌风险的影响引起了人们的兴趣，因为许多常用的药物会影响胃的内稳态。非甾体抗炎药（NSAIDs）是胃溃疡病的常见病因，而低剂量阿司匹林已被推广用于预防多种肿瘤实体的发生。环氧化酶抑制对胃癌预防的有益作用是合理的，但其实践意义尚不清楚。此外，他汀类药物和二甲双胍也被认为具有抗肿瘤作用。相反，质子泵抑制剂（PPIs）常用于预防胃溃疡和出血，但在大型观察性研究中与胃癌风险增加相关。这些观察结果大多仍需要前瞻性对照试验来证实。NSAIDs、他汀类药物和二甲双胍也被作为癌症的辅助治疗进行了研究，但迄今为止，这些研究并未显示出令人信服的结果。在这里，我们回顾了 PPI、NSAIDs、他汀类药物和二甲双胍在胃癌发生中的作用的现有证据和可能机制，并讨论了其对临床实践的可能影响。
