Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Int J Cancer. 2021 Sep 15;149(6):1228-1238. doi: 10.1002/ijc.33678. Epub 2021 May 24.
Helicobacter pylori (Hp) is crucial in gastric carcinogenesis, but infection alone is not a sufficient cause, and the interaction between Hp infection and other risk factors has not been adequately studied. We conducted a pooled analysis of seven case-control studies from the Stomach cancer Pooling (StoP) Project, comprising 1377 cases and 2470 controls, to explore the interaction among Hp infection and tobacco smoking, alcohol drinking, socioeconomic status (SES) and dietary salt intake on the risk of gastric cancer. We estimated summary odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) by multivariate unconditional logistic regression. The analysis showed no consistent interaction between Hp infection and cigarette smoking, while interaction was more than multiplicative for alcohol drinking (OR = 1.38, 95% CI: 1.07-1.77, P-interaction 0.02) and high intake of salt (OR = 2.62, 95% CI: 1.88-3.65, P-interaction = 0.04). The interaction with SES followed the multiplicative model (P = 0.49), resulting in a weakening among infected individuals of the protective effect of high SES among observed Hp-negative individuals. The interactions found were more pronounced in subjects with history of peptic ulcer. The interactions with Hp infection were stronger for cigarette smoking and dietary salt in the case of noncardia cancer, and for alcohol and SES in the case of cardia cancer. No differences were found when stratifying for histologic type. This large-scale study aimed to quantify the interaction between Hp infection and other modifiable risk factors of gastric cancer revealed that the benefit of combined Hp eradication and lifestyle modification on gastric cancer prevention may be larger than commonly appreciated.
幽门螺杆菌(Hp)在胃癌发生中起着关键作用,但感染本身并不是充分的原因,Hp 感染与其他危险因素之间的相互作用尚未得到充分研究。我们对来自胃癌汇集(StoP)项目的 7 项病例对照研究进行了汇总分析,共包括 1377 例病例和 2470 例对照,以探讨 Hp 感染与吸烟、饮酒、社会经济状况(SES)和膳食盐摄入量之间的相互作用对胃癌的风险。我们通过多变量非条件逻辑回归估计了汇总比值比(OR)及其相应的 95%置信区间(CI)。分析表明,Hp 感染与吸烟之间没有一致的相互作用,而饮酒(OR=1.38,95%CI:1.07-1.77,P 交互作用 0.02)和高盐摄入(OR=2.62,95%CI:1.88-3.65,P 交互作用 0.04)的相互作用则超过了乘法模型。SES 的相互作用遵循乘法模型(P=0.49),导致观察到 Hp 阴性个体中 SES 较高的保护作用在感染个体中减弱。在有消化性溃疡病史的人群中,发现的相互作用更为明显。在非贲门癌病例中,与 Hp 感染的相互作用在吸烟和膳食盐方面更强,而在贲门癌病例中,与酒精和 SES 的相互作用更强。在组织学类型分层时没有发现差异。这项大规模研究旨在量化 Hp 感染与胃癌其他可改变危险因素之间的相互作用,结果表明,联合 Hp 根除和生活方式改变对预防胃癌的益处可能比人们通常认为的更大。
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