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Impact of the timing of Helicobacter pylori eradication on the risk of development of metachronous lesions after treatment of early gastric cancer: a population-based cohort study

      Background and Aims

      Helicobacter pylori eradication can reduce the risk of metachronous lesions after the treatment of early gastric cancer. We aimed to analyze the impact of the timing of H pylori eradication on metachronous recurrence.

      Methods

      Data of patients who underwent endoscopic resection or partial gastrectomy for early stage gastric cancer and received H pylori eradication therapy were obtained from the Korean National Health Insurance Service database. Patients were classified into 3 groups according to the timing of the prescription for H pylori eradication: preresection; within 1 year postresection; and >1 year postresection.

      Results

      Among 19,767 patients, 7452 and 12,315 underwent endoscopic resection and surgery, respectively. The 5-year cumulative incidence of metachronous lesions after endoscopic resection was 14.0% in the preresection group, 12.3% in the within 1 year postresection group, and 16.9% in the >1 year postresection group. Surgery was performed in 1.2% of the preresection group, 1.3% of the within 1 year postresection group, and 2.9% of the >1 year postresection group. The within 1 year postresection group had a lower risk of development of metachronous lesions than the >1 year postresection group (hazard ratio [95% confidence interval]: after endoscopic resection, 0.79 [0.65–0.95]; after surgery, 0.39 [0.28–0.53]). The risk of development of metachronous lesions did not differ between the preresection and within 1 year postresection groups.

      Conclusion

      Prescription of H pylori eradication therapy within 1 year after gastric cancer treatment reduces the risk of development of metachronous gastric neoplasms compared with a late prescription of eradication therapy in patients undergoing endoscopic resection and those undergoing surgery.

      Abbreviations:

      BMI (body mass index), CI (confidence interval), EGC (early gastric cancer), HR (hazard ratio), ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), IQR (interquartile range), NHIS (National Health Insurance Service), RCT (randomized controlled trial)
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      References

        • Park C.H.
        • Lee H.
        • Kim D.W.
        • et al.
        Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis.
        Gastrointest Endosc. 2014; 80: 599-609
        • Chon H.J.
        • Hyung W.J.
        • Kim C.
        • et al.
        Differential prognostic implications of gastric signet ring cell carcinoma: stage adjusted analysis from a single high-volume center in Asia.
        Ann Surg. 2017; 265: 946-953
        • Nozaki I.
        • Hato S.
        • Kobatake T.
        • et al.
        Incidence of metachronous gastric cancer in the remnant stomach after synchronous multiple cancer surgery.
        Gastric Cancer. 2014; 17: 61-66
        • Hanyu T.
        • Wakai A.
        • Ishikawa T.
        • et al.
        Carcinoma in the remnant stomach during long-term follow-up after distal gastrectomy for gastric cancer: analysis of cumulative incidence and associated risk factors.
        World J Surg. 2018; 42: 782-787
        • Choi I.J.
        • Kook M.C.
        • Kim Y.I.
        • et al.
        Helicobacter pylori therapy for the prevention of metachronous gastric cancer.
        N Engl J Med. 2018; 378: 1085-1095
        • Okada K.
        • Suzuki S.
        • Naito S.
        • et al.
        Incidence of metachronous gastric cancer in patients whose primary gastric neoplasms were discovered after Helicobacter pylori eradication.
        Gastrointest Endosc. 2019; 89: 1152-1159 e1
        • Fukase K.
        • Kato M.
        • Kikuchi S.
        • et al.
        Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial.
        Lancet. 2008; 372: 392-397
        • Choi J.M.
        • Kim S.G.
        • Choi J.
        • et al.
        Effects of Helicobacter pylori eradication for metachronous gastric cancer prevention: a randomized controlled trial.
        Gastrointest Endosc. 2018; 88: 475-485.e2
        • Kim Y.I.
        • Cho S.J.
        • Lee J.Y.
        • et al.
        Effect of Helicobacter pylori eradication on long-term survival after distal gastrectomy for gastric cancer.
        Cancer Res Treat. 2016; 48: 1020-1029
        • Song S.O.
        • Jung C.H.
        • Song Y.D.
        • et al.
        Background and data configuration process of a nationwide population-based study using the korean national health insurance system.
        Diabetes Metab J. 2014; 38: 395-403
        • Lee Y.H.
        • Han K.
        • Ko S.H.
        • et al.
        Data analytic process of a nationwide population-based study using national health information database established by National Health Insurance Service.
        Diabetes Metab J. 2016; 40: 79-82
        • Choi J.
        • Kim H.J.
        • Lee J.
        • et al.
        Risk of hepatocellular carcinoma in patients treated with entecavir vs tenofovir for chronic hepatitis B: a Korean nationwide cohort study.
        JAMA Oncol. 2019; 5: 30-36
        • Choi Y.J.
        • Lee S.H.
        • Cho Y.S.
        • et al.
        Analysis of recent changes in surgery and pathologic examination methods for gastric cancer patients and analysis of gastric cancer screening efficacy [Korean].
        Institute of National Health Insurance Service Ilsan Hospital, 2017 (Report 2017-20-025)
        • Crew K.D.
        • Neugut A.I.
        Epidemiology of gastric cancer.
        World J Gastroenterol. 2006; 12: 354-362
        • IARC Working Group on the Evaluation of Carcinogenic Risks to Humans
        Some industrial chemicals.
        IARC Monogr Eval Carcinog Risks Hum. 1994; 60: 1-560
        • Wong B.C.
        • Lam S.K.
        • Wong W.M.
        • et al.
        Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial.
        JAMA. 2004; 291: 187-194
        • Leung W.K.
        • Lin S.R.
        • Ching J.Y.
        • et al.
        Factors predicting progression of gastric intestinal metaplasia: results of a randomised trial on Helicobacter pylori eradication.
        Gut. 2004; 53: 1244-1249
        • You W.C.
        • Brown L.M.
        • Zhang L.
        • et al.
        Randomized double-blind factorial trial of three treatments to reduce the prevalence of precancerous gastric lesions.
        J Natl Cancer Inst. 2006; 98: 974-983
        • Mizuno S.
        • Miki I.
        • Ishida T.
        • et al.
        Prescreening of a high-risk group for gastric cancer by serologically determined Helicobacter pylori infection and atrophic gastritis.
        Dig Dis Sci. 2010; 55: 3132-3137
        • Miki K.
        Gastric cancer screening by combined assay for serum anti-Helicobacter pylori IgG antibody and serum pepsinogen levels-"ABC method".
        Proc Jpn Acad Ser B Phys Biol Sci. 2011; 87: 405-414
        • Kudo T.
        • Kakizaki S.
        • Sohara N.
        • et al.
        Analysis of ABC (D) stratification for screening patients with gastric cancer.
        World J Gastroenterol. 2011; 17: 4793-4798
        • Abe S.
        • Oda I.
        • Minagawa T.
        • et al.
        Metachronous gastric cancer following curative endoscopic resection of early gastric cancer.
        Clin Endosc. 2018; 51: 253-259

      Linked Article

      • Has the issue of the “point of no return” in gastric carcinogenesis already been resolved?
        Gastrointestinal EndoscopyVol. 94Issue 1
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          We have read the article focusing on the timing of Helicobacter pylori eradication on the risk of development of metachronous gastric cancer (MGC) after treatment of early gastric cancer (EGC) by Kim et al.1 The authors showed that the timing of H pylori eradication within 1 year after treatment was better to reduce the risk of development of MGC than the late timing based on a large-scale national insurance database. They described that this finding was supported by a randomized controlled study by Choi et al2 showing that H pylori eradication after endoscopic resection (ER) of EGC improved atrophy and intestinal metaplasia during the 3-year follow-up.
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