根除治疗对肠化生或发育异常患者胃癌风险的影响：一项随机对照试验的荟萃分析

Effect of eradication on gastric cancer risk in patients with intestinal metaplasia or dysplasia: a meta-analysis of randomized controlled trials.

作者信息

Fu Qiang, Yu Huidong, Liu Ming, Chen Liang, Chen Weiyang, Wang Ziyi, Li Wenya

机构信息

Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China.

State Key Laboratory of Molecular Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Front Microbiol. 2025 Mar 12;16:1530549. doi: 10.3389/fmicb.2025.1530549. eCollection 2025.

DOI:10.3389/fmicb.2025.1530549

PMID:40143868

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11938427/

Abstract

BACKGROUND

Observational studies suggest that () is associated with an increased risk of gastric cancer, yet the effect of eradication on gastric cancer risk in patients with intestinal metaplasia (IM) or dysplasia remains controversial. The purpose of this study was to summarize the evidence from randomized controlled trials (RCTs) investigating eradication on gastric cancer risk in patients with IM or dysplasia to determine the evidence base.

METHODS

PubMed, Embase, Cochrane Library, Web of science and China National Knowledge Internet database were searched for RCTs published through May 2024 in adults with IM or dysplasia comparing the risk of gastric cancer following eradication versus no eradication therapy. Relative risk (RR) with its 95% confidence interval (CI) using random-effects model were employed for the effect estimate. Sensitivity, meta-regression, and subgroup analyses were also calculated.

RESULTS

Sixteen RCTs involving 15,027 patients with IM or dysplasia met the inclusion criteria. In a pooled analysis, eradication resulted in a 45% reduction in RR for gastric cancer risk relative to no eradication (RR: 0.55; 95% CI: 0.46-0.67;  < 0.001). eradication significantly reduced the risk of gastric cancer in patients with dysplasia (RR: 0.51; 95% CI: 0.32-0.82;  = 0.005), and IM (RR: 0.61; 95% CI: 0.40-0.93;  = 0.022). Further, if the study conducted in countries other than those in Asia, sample size <500, percentage of male <50.0%, follow-up duration <5.0 years, and low study quality, then there was no significant association between eradication and a decreased risk of gastric cancer.

CONCLUSION

eradication is protective against gastric cancer in patients with IM or dysplasia.

SYSTEMATIC REVIEW REGISTRATION

INPLASY202530010, https://inplasy.com/.

摘要

背景

观察性研究表明，（）与胃癌风险增加相关，但根除（）对肠化生（IM）或发育异常患者胃癌风险的影响仍存在争议。本研究的目的是总结随机对照试验（RCT）的证据，这些试验调查了根除（）对IM或发育异常患者胃癌风险的影响，以确定证据基础。

方法

检索了PubMed、Embase、Cochrane图书馆、Web of science和中国知网数据库，查找截至2024年5月发表的关于IM或发育异常成人的RCT，比较根除（）治疗与未根除治疗后胃癌的风险。采用随机效应模型的相对风险（RR）及其95%置信区间（CI）进行效应估计。还计算了敏感性、Meta回归和亚组分析。

结果

16项涉及15,027例IM或发育异常患者的RCT符合纳入标准。在汇总分析中，相对于未根除，根除（）使胃癌风险的RR降低了45%（RR：0.55；95%CI：0.46-0.67；＜0.001）。根除（）显著降低了发育异常患者（RR：0.51；95%CI：0.32-0.82；=0.005）和IM患者（RR：0.61；95%CI：0.40-0.93；=0.022）的胃癌风险。此外，如果研究在亚洲以外的国家进行，样本量＜500，男性百分比＜50.0%，随访时间＜5.0年，且研究质量较低，那么根除（）与胃癌风险降低之间无显著关联。