Abstract
Gastric cancer is the second leading course of cancer death worldwide and H. pylori infection is an important risk factor for gastric cancer development. This study was design to evaluate the clinical, pathological features, survival rate and prevalence of H. pylori infection in gastric cancer in Thailand. Clinical information, histological features, endoscopic findings and H. pylori status were collected from gastric cancer patients from Thammasat university hospital during June 1996-December 2011. H. pylori infection was assessed by histological evaluation, rapid urease test and serological test. Clinical information, endoscopic findings and histopathology of all patients were recorded and compared between patients with active or non-active H. pylori infection. A total of 100 gastric cancer patients (55 men and 45 women with mean age of 55±16.8 years) were enrolled in this study. Common presenting symptoms were dyspepsia (74%), weight loss (66%), anemia (63%) and anorexia (38%). Mean duration of symptoms prior to diagnosis was 98 days. Overall prevalence of H. pylori infection was 83% and active H. pylori infection was 40%. 1-year and 5-year survival rates were 43% and 0%. There was no significant difference between active H. pylori infection in different locations (proximal vs non-proximal: 47.1% vs 48.5%; P-value=0.9, OR=0.9; 95%CI=0.3-3.1) and histology of gastric cancer (diffuse type vs intestinal type: 47.4% vs 50%; P-value=0.8, OR=0.9, 95%CI=0.3-2.7). However, linitis plastica was significantly more common in non-active than active H. pylori infection (27.9% vs 0%; P-value<0.0001, OR=13.3, 95%CI=3.2-64.5). Moreover, gastric cancer stage 4 was higher in non-active than active H. pylori infection (93% vs 50%, P-value<0.001). Prevalence of H. pylori infection in Thai gastric cancer patients was high but active infection was low. Most gastric cancer patients presented in advance stage and had a grave prognosis. Screening for gastric cancer in high risk individuals might be an appropriate tool for early detection and improve the treatment outcome for this particular disease in Thailand.
Highlights
Gastric cancer is the fourth most common cancer worldwide, with nearly 1 million cases per year
There was no significant difference between active H. pylori infection in different locations and histology of gastric cancer
(Warren et al, 1983), many studies have suggested the relationship between H. pylori infection and gastric cancer (Parsonnet et al, 1991, Uemura et al, 2001, Demirel et al, 2013, Karami et al, 2013)
Summary
Gastric cancer is the fourth most common cancer worldwide, with nearly 1 million cases per year. Three quarters of gastric cancer occur in Asia, with 80% of cases originating in Japan and China. The prevalence of gastric cancer is highest in Asian countries, as mentioned above, but the prevalence of gastric cancer varies among different countries in Asia despite high rate of infection with H. pylori in these countries (Vilaichone et al, 2006; Mahachai et al, 2011). Prevalence of H. pylori infection in gastric cancer varies from 19% to 94% according to study from Spain (Martin-de Argila et al, 1997). In Thailand, there are few studies on this area and the prevalence of H. pylori in gastric cancer may be underestimated. We conducted this study to evaluate the prevalence of active H. pylori infection and to compare the clinical spectrum and histology between active and non-active H. pylori infection of gastric cancer patients in our country
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