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. 2020 Mar;55(3):281-288.
doi: 10.1007/s00535-019-01639-w. Epub 2019 Oct 30.

Risk of gastric cancer in the second decade of follow-up after Helicobacter pylori eradication

Susumu Take  1   2 , Motowo Mizuno  3 , Kuniharu Ishiki  2 , Chiaki Kusumoto  2 , Takayuki Imada  2 , Fumihiro Hamada  4 , Tomowo Yoshida  2 , Kenji Yokota  5 , Toshiharu Mitsuhashi  6 , Hiroyuki Okada  7
Affiliations

Risk of gastric cancer in the second decade of follow-up after Helicobacter pylori eradication

Susumu Take et al. J Gastroenterol. 2020 Mar.

Erratum in

Abstract

Background and aims: Eradication of Helicobacter pylori reduces the risk of gastric cancer. In this study, we investigated the risk beyond 10 years after eradication of H. pylori.

Methods: We conducted a retrospective cohort study of 2737 patients who had yearly endoscopic follow-up after cure of H. pylori infection. For comparison of gastric cancer risk in the second decade of follow-up with that in the first decade, we calculated standardized incidence ratios (SIRs) by dividing the number of observed cases of gastric cancer in the second decade of follow-up by that of expected cases which was estimated using the incidence rate ratio of age in the first decade.

Results: During the follow-up for as long as 21.4 years (mean 7.1 years), gastric cancer developed in 68 patients (0.35% per year). The SIRs for diffuse-type gastric cancer was infinity (0 expected case and 4 observed cases) in patients with mild gastric mucosal atrophy and 10.9 (95% confidence interval 4.53-26.1) with moderate atrophy, whereas no significant increase of SIRs was observed in intestinal-type cancer regardless of the grade of baseline gastric atrophy or in diffuse-type cancer in patients with severe atrophy even though who had the highest risk.

Conclusions: The longer the follow-up, the greater the risk of developing diffuse-type gastric cancer becomes in patients with mild-to-moderate gastric atrophy at baseline. Endoscopic surveillance should be continued beyond 10 years after cure of H. pylori irrespective of the severity of gastric atrophy.

Keywords: Diffuse-type gastric cancer; Eradication therapy; Gastric atrophy; Helicobacter pylori.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Kaplan–Meier analysis of the proportion of patients who remained free of gastric cancer after cure of H. pylori infection. Asterisk: the annual risk of developing gastric cancer calculated by Kaplan–Meier analysis
Fig. 2
Fig. 2
Kaplan–Meier analysis of the proportion of patients who remained free of gastric cancer after cure of H. pylori infection according to grade of background gastric mucosal atrophy at the time of eradication therapy (a) and histological type of gastric cancer (b) during the total follow-up period as long as 21 years. Asterisk: the annual risk of developing gastric cancer calculated by Kaplan–Meier analysis. Dagger: statistical significance between curves tested by log-rank test
Fig. 3
Fig. 3
Kaplan–Meier analysis of the proportion of patients who remained free of gastric cancer after cure of H. pylori infection according to grade of background gastric mucosal atrophy at the time of eradication therapy, histological types of gastric cancer, and follow-up period. Dotted line: Kaplan–Meier curve of patients free of gastric cancer in the first 10 years after cure of H. pylori infection. Line: Kaplan–Meier curve of patients free of gastric cancer in the second decade of follow-up, which was created from the 10 years as starting point
See this image and copyright information in PMC

Comment in

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