Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland.
Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Helicobacter. 2023 Jun;28(3):e12979. doi: 10.1111/hel.12979. Epub 2023 Apr 3.
Long-term Helicobacter pylori infection increases the risk of gastric malignancies. Since the symptoms for H. pylori gastritis, as well as for several malignancies, may be nonexisting or highly unspecific, even H. pylori-positive subjects with underlying malignancies may receive eradication therapy. The aim was to assess the incidence of gastrointestinal and various other malignancies in individuals after eradication therapy for H. pylori infection.
A cohort of 217,554 subjects (120,344 women and 97,210 men), who had purchased specific combinations of drugs for H. pylori eradication therapy in 1994-2004, was identified by the Finnish National Prescription Registry and followed for cancer incidence until the end of 2008 (1.89 million person-years at risk).
A total of 22,398 malignancies were identified in the cohort. In both genders, for the first 6 months after drug prescription, the standardized incidence ratios (SIRs) were between 5 and 32 for gastric, colorectal, and pancreatic cancers, and 2 and 3 for several other malignancies. Although later on the SIRs of most malignancies fell rapidly, those of gastric noncardia and lung cancers remained elevated up to 5 years of follow-up. The only SIRs below unity were seen in men for gastric cancers (cardia 0.61, 95% CI: 0.37-0.95; intestinal noncardia 0.74, 95% CI: 0.56-0.97) during the post-therapy period covering years 5-15.
Incidence levels significantly above the population rates were detected for many malignancies. Although eradication of H. pylori may have a long-lasting protective effect against gastric cancer, H. pylori therapy may postpone the detection of malignancies possibly underlying unspecific gastrointestinal symptoms. Therefore, it should be emphasized that the diagnostic work-up for malignancies should not be stopped in case of detection and treatment of H. pylori infection.
长期幽门螺杆菌感染会增加胃癌的风险。由于幽门螺杆菌胃炎以及某些恶性肿瘤的症状可能不存在或高度不特异，即使是幽门螺杆菌阳性且患有潜在恶性肿瘤的患者也可能接受根除治疗。本研究旨在评估幽门螺杆菌感染根除治疗后个体发生胃肠道和其他各种恶性肿瘤的发生率。
通过芬兰国家处方登记处，确定了 1994 年至 2004 年期间购买特定幽门螺杆菌根除治疗药物组合的 217554 名受试者（女性 120344 名，男性 97210 名）组成队列，并随访至 2008 年底（风险人群 189 万人年），以评估癌症的发病率。
该队列中共发现 22398 例恶性肿瘤。在两性中，药物处方后 6 个月内，胃癌、结直肠癌和胰腺癌的标准化发病比（SIR）在 5 到 32 之间，而其他几种恶性肿瘤的 SIR 在 2 到 3 之间。尽管后来大多数恶性肿瘤的 SIR 迅速下降，但胃非贲门癌和肺癌的 SIR 直到 5 年随访期仍处于高位。仅在男性中观察到胃癌（贲门癌 0.61，95%CI：0.37-0.95；非贲门胃 0.74，95%CI：0.56-0.97）的 SIR 低于 1，该 SIR 涵盖了治疗后 5 到 15 年的时间段。
许多恶性肿瘤的发病率水平明显高于人群发病率。虽然根除幽门螺杆菌可能对胃癌具有长期保护作用，但幽门螺杆菌治疗可能会延迟潜在的非特异性胃肠道症状的恶性肿瘤的发现。因此，应强调如果发现并治疗幽门螺杆菌感染，不应停止恶性肿瘤的诊断性检查。
