Failure of Helicobacter pylori eradication and age are independent risk factors for recurrent neoplasia after endoscopic resection of early gastric cancer in 283 patients

• Published in: Alimentary pharmacology & therapeutics Vol. 39; no. 6; pp. 609 - 618
• Main Authors: Kwon, Y. H., Heo, J., Lee, H. S., Cho, C. M., Jeon, S. W.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell 01-03-2014
• Subjects: Age Factors; Aged; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Dissection - methods; Female; Follow-Up Studies; Gastric Mucosa - pathology; Gastroenterology. Liver. Pancreas. Abdomen; Gastroscopy - adverse effects; Helicobacter Infections - complications; Helicobacter Infections - drug therapy; Helicobacter pylori - isolation & purification; Human bacterial diseases; Humans; Incidence; Infectious diseases; Male; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Recurrence; Retrospective Studies; Risk Factors; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Human; Endoscopic surgery; Asynchronous; Relapse; Spirillales; Spirillaceae; Malignant tumor; Eradication; Stomach cancer; Epidemiology; Infection; Treatment; Helicobacter pylori; Risk factor; Bacteriosis; Bacteria; Digestive diseases; Early; Age; Failure; Cancer; Gastric disease
• DOI: 10.1111/apt.12633
• EISSN: 1365-2036
• ISSN: 0269-2813

Summary
Background
Whether the incidence of metachronous gastric dysplasia and cancer could be decreased by eradication of Helicobacter pylori after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).
Aim
To compare the incidence of metachronous gastric lesion in the eradicated group and the persistent group. Second end point is to evaluate the risk factors for metachronous gastric lesions after ESD for EGC.
Methods
In a single centre, between May 2007 and May 2010, the patients who had evidence of H. pylori infection at the time of ESD for EGC were included, and the follow‐up data were analysed retrospectively.
Results
We enrolled 283 patients who have shown H. pylori infection at the time of ESD for EGC. Successful eradication was achieved for 214 patients (75.6%) (Eradicated group), and 69 patients (24.4%) showed persistent H. pylori infection (Persistent group). Metachronous gastric lesions developed in 13 (18.8%) in the persistent group and 18 (8.4%) in the eradicated group (P = 0.016). In the ≥60‐year‐old group, the cumulative incidence of metachronous gastric cancer showed a significant increase (P = 0.012). Cumulative hazard ratio of subsequent gastric metachronous lesions differed between the eradication group and the persistent infection group (OR = 2.322, 95% CI = 1.136–4.744, P = 0.021), and ≥60 age at the time of endoscopic resection (OR = 2.803, 95% CI = 1.207–6.509, P = 0.016).
Conclusions
Both persistent H. pylori infection and old age (≥60) are independent risk factors for the increased incidence of metachronous gastric cancer.