Risk Of Gastric Cancer In Patients Research Articles

Endoscopic and histological risk stratification for gastric cancer using gastric intestinal metaplasia.

Intestinal metaplasia (IM) of the gastric mucosa is strongly associated with the risk of gastric cancer (GC). This study was performed to investigate the usefulness of endoscopic and histological risk stratification for GC using IM. This was a post-hoc analysis of a multicenter prospective study involving 10 Japanese facilities (UMINCTR000027023). The ridge/tubulovillous pattern, light blue crest (LBC), white opaque substance (WOS), endoscopic grading of gastric IM (EGGIM) score using non-magnifying image-enhanced endoscopy, and operative link on gastric IM assessment (OLGIM) were evaluated for their associations with GC risk in all patients. In total, 380 patients (115 with GC and 265 without GC) were analyzed. The presence of an LBC (limited to antrum: odds ratio [OR] 2.4 [95% confidence interval 1.1-5.0], extended to corpus: OR 3.6 [2.1-6.3]), the presence of WOS (limited to antrum: OR 3.0 [1.7-5.3], extended to corpus: OR 4.2 [2.1-8.2]), and histological IM (limited to antrum: OR 3.2 [1.4-7.4], extended to corpus: OR 8.5 [4.5-16.0]) were significantly associated with GC risk. Additionally, the EGGIM score (5-8 points: OR 8.8 [4.4-16.0]) and OLGIM (stage III/IV: OR 12.5 [6.1-25.8]) were useful for stratification of GC risk. The area under the receiver operating characteristic curve value for GC risk was 0.740 for OLGIM and 0.706 for EGGIM. The LBC, WOS, EGGIM, and OLGIM were strongly associated with GC risk in Japanese patients. This finding can be useful for GC risk assessment in daily clinical practice.

Intentional obesity reduction and the occurrence of gastric cancer – literature review

Introduction: Gastric cancer (GC) is one of most common cancers worldwide. Reducing exposure to risk factors, along with screening and early detection, are crucial for prevention. Many studies have linked obesity to GC. Weight loss can be achieved through proper diet and exercise. For patients with a body mass index (BMI) of 40 or higher, or 35 or higher with serious obesity-related comorbidities, bariatric surgery can be a means of weight reduction. This raises the question of whether intentional weight loss can lower the risk of GC in the population. Purpose of the study: The aim of this study is to collect and summarize existing evidence on connection of bariatric surgery and lower GC risk and mortality in patients with obesity. Material and method: Literature review was performed, in English databases, using keywords : cancer, gastric cancer, bariatric surgery, prevention, obesity, survival in gastric cancer. Results and conclusion: It is widely recognized that obesity increases the risk of GC, and bariatric surgery is an effective method for weight reduction. Bariatric surgery is the most effective treatment for sustained weight loss and remission of obesity-related conditions. A systematic review conducted on this topic revealed that bariatric surgery is linked to a reduced risk of GC in patients with obesity. Compared to no surgery, bariatric surgery was found to be associated with significantly lower rates of obesity-associated cancer and cancer-related mortality. Weight loss after bariatric surgery provides significant health benefits.

Gastric Cancer Risk in Patients with Long-Term Use of Proton Pump Inhibitors: A Systematic Review and Meta-Analysis of Observational and Interventional Studies.

A growing number of studies that differ in design, quality, and results report an association between the use of proton pump inhibitors (PPIs) and the risk of gastric cancer (GC). We conducted a systematic review and meta-analysis, when possible, of observational and interventional studies examining PPI use and risk of GC. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified studies fully published in English through January 2023 using MeSH and non-MeSH keywords. We used random effects models to calculate pooled risk estimates with 95% confidence interval (CI) between PPI use and overall GC, cardia GC, and non-cardia GC. We estimated heterogeneity (I2) among studies. We examined the effect of study design and quality, GC site, H. pylori infection, and PPI duration. We assessed quality using the Newcastle-Ottawa Quality Assessment Scale and Risk Of Bias In Non-randomized Studies of Interventions. We identified 15 observational studies, of which 13 were included in the meta-analysis (six cohort and seven case-control). There was a modest 1.67-fold increase in overall GC risk (95% CI 1.39, 2.00) and no increase in cardia GC risk [odds ratio (OR) 1.12; 95% CI 0.80, 1.56] with PPI use. However, there was high heterogeneity (I2 = 61.3%, p = 0.004) among studies. All but one study had at least moderate risk of bias. In the six studies accounting for H. pylori, GC risk associated with PPI use increased slightly (OR 1.78; 95% CI 1.25, 2.52). Duration response was not reported consistently to allow pooled estimates. We identified only one interventional randomized controlled study that included GC as an outcome of interest, and it did not show increased GC risk. The overall available evidence is not supportive of a meaningful change in GC risk, either cardia or non-cardia, with PPI use.

Clinical Application of the Kyoto Classification of Gastritis

Recent advances in endoscopic technology, including high-definition and image-enhanced endoscopy such as narrow-band imaging have facilitated close observation and detailed imaging of the gastric mucosa. Currently, endoscopy is performed in Korea primarily for evaluation of premalignant conditions and gastric cancer detection. Recent research has established the Kyoto classification of gastritis, a novel grading system for endoscopic gastritis, which enables prediction of Helicobacter pylori (H. pylori) infection. The Kyoto classification score is calculated based on the sum of scores for five main items (of 19 endoscopic findings indicative of H. pylori infection) such as atrophy, intestinal metaplasia, enlarged gastric folds, nodularity, and diffuse redness with/without regular arrangement of collecting venules (RAC). Of these five endoscopic findings, atrophy, intestinal metaplasia, enlarged gastric folds, and nodularity are associated with an increased risk and RAC with a decreased risk of gastric cancer. Previous studies have reported that a Kyoto classification score ≥2 indicates current or past H. pylori infection. An increase in the Kyoto classification score is associated with a high risk of gastric cancer; specifically, a Kyoto classification score ≥4 indicates a high risk of gastric cancer. However, H. pylori eradication is followed by disappearance of enlarged gastric folds, nodularity, and diffuse redness; therefore, this grading system cannot accurately reflect the gastric cancer risk in patients with previous H. pylori infection. Limited studies have discussed the Kyoto classification of gastritis in Korea. Therefore, further large-scale multicenter studies are warranted for validation of the Kyoto classification to predict H. pylori infection and gastric cancer risk.

Risk of gastric cancer among patients with newly diagnosed ulcerative colitis: A nationwide population-based study.

471 Background: We aimed to assess gastric cancer risk in patients with newly diagnosed ulcerative colitis (UC). Methods: Based on claims data of the Korean National Health Insurance from January 2006 to December 2015, we identified 30,546 patients with UC and randomly selected 88,829 age- and sex-matched non-UC individuals (controls). Hazard ratios (HRs) adjusted for covariates were calculated using multivariate Cox proportional-hazards regression. Results: Overall, 77 (0.25%) patients with UC and 383 (0.43%) non-UC individuals developed gastric cancer during the period. HR of UC was 0.60 (95% CI: 0.47–0.77) for gastric cancer, compared to non-UC individuals. When stratified according to age and sex, HRs in 20-39, 40-59, and ≥ 60 years of age at diagnosis of UC were 0.19 (95% CI: 0.04–0.98), 0.65 (95% CI: 0.45–0.94), and 0.60 (95% CI: 0.49–0.80), and HR of male UC patients was 0.54 (95% CI: 0.41–0.73) for gastric cancer. However, among UC patients, multivariable analysis revealed that HR in ≥ 60 years of age at diagnosis of UC were 12.34 (95% CI: 2.23-68.16), consistent with old age as a risk factor of gastric cancer in general population. Conclusions: Patients with UC had a decreased gastric cancer risk compared with non-UC individuals. Further research is needed to elucidate the reason.

P877 Risk of gastric cancer among patients with incident ulcerative colitis: A nationwide population based study

Abstract Background Few studies have investigated the risk of gastric cancer (GC) in ulcerative colitis (UC), with inconsistent results. This study assessed GC risk in patients with newly diagnosed UC. Methods Using claims data of the Korean National Health Insurance (NHI) from January 2006 to December 2015, we identified incident UC patients. UC was defined using the International Classification of Diseases-10 codes and UC-specific prescriptions. Age and sex-matched non-UC individuals during the same period were randomly selected as controls from the NHI database. Hazard ratios (HRs), adjusted for covariates, were calculated using multivariate Cox proportional-hazards regression. Results From 2006 to 2015, 30,546 patients diagnosed with UC and 88,829 matched non-UC individuals were included. GC developed in 77 (0.25%) UC and 383 (0.43%) non-UC individuals. The HR for GC in UC patients was 0.60 (95%CI: 0.47–0.77) compared to non-UC individuals. When stratified according to age and sex, the HR for late-onset UC (≥40 years) was 0.63 (95%CI: 0.49–0.80) compared to non-UC for the same age, and the HR of male UC patients was 0.55 (95%CI: 0.33– 0.89), compared to non-UC men. Among UC patients, the HR for age ≥40 years was 23.37 (95%CI: 6.38–85.64). Conclusion UC patients had a decreased GC risk compared to non-UC individuals. In particular, UC patients aged ≥40 years and male UC patients had a decreased risk of GC compared to non-UC individuals. However, among UC patients, late-onset UC (≥40 years) had a higher risk of GC than early-onset UC.

U-Net deep learning model for endoscopic diagnosis of chronic atrophic gastritis and operative link for gastritis assessment staging: a prospective nested case–control study

Background: The operative link for the gastritis assessment (OLGA) system can objectively reflect the stratification of gastric cancer risk in patients with chronic atrophic gastritis (CAG). Objectives: We developed a real-time video monitoring model for the endoscopic diagnosis of CAG and OLGA staging based on U-Net deep learning (DL). To further validate and improve its performance, we designed a study to evaluate the diagnostic evaluation indices. Design: A prospective nested case–control study Methods: Our cohort consisted of 1306 patients from 31 July 2021 to 31 January 2022. According to the pathological results, patients in the cohort were divided into the CAG group and the chronic non-atrophic gastritis group to evaluate the diagnostic evaluation indices. Each atrophy lesion was automatically labeled and the atrophy severity was assessed by the model. Propensity score matching was used to minimize selection bias. Results: The diagnostic evaluation indices and the consistency between OLGA staging and pathological diagnosis of the model were superior to those of endoscopists [sensitivity (89.31% versus 67.56%), specificity (90.46% versus 70.23%), positive predictive value (90.35% versus 69.41%), negative predictive value (89.43% versus 68.40%), accuracy rate (89.89% versus 68.89%), Youden index (79.77% versus 37.79%), odd product (79.23 versus 4.91), positive likelihood ratio (9.36 versus 2.27), negative likelihood ratio (0.12 versus 0.46)], areas under the curves (AUC) (95% CI) (0.919 (0.893–0.945) versus 0.749 (0.707–0.792), p < 0.001) and kappa (0.816 versus 0.291)]. Conclusion: Our study demonstrated that the DL model can assist endoscopists in real-time diagnosis of CAG during gastroscopy and synchronous identification of high-risk OLGA stage (OLGA stages III and IV) patients. Trial registration: ChiCTR2100044458.

Identification of Combinations of Plasma lncRNAs and mRNAs as Potential Biomarkers for Precursor Lesions and Early Gastric Cancer.

Patients with gastric cancer (GC) are usually first diagnosed at an advanced stage due to the absence of obvious symptoms at an early GC (EGC) stage. Therefore, it is necessary to identify an effective screening method to detect precursor lesions of GC (PLGC) and EGC to increase the 5-year survival rate of patients. Cell-free RNA, as a biomarker, has shown potential in early diagnosis, personalised treatment, and prognosis of cancer. In this study, six RNAs (CEBPA-AS1, INHBA-AS1, AK001058, UCA1, PPBP, and RGS18) were analysed via real-time quantitative polymerase chain reaction (RT-qPCR) using the plasma of patients with EGC and PLGC to identify diagnostic biomarkers. The receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic accuracy. Among the six RNAs, four lncRNAs (CEBPA-AS1, INHBA-AS1, AK001058, and UCA1) were upregulated and two mRNAs (PPBP and RGS18) were downregulated in the plasma of patients with PLGC and EGC. According to the findings of the ROC analysis, the four-RNA combination of INHBA-AS1, AK001058, UCA1, and RGS18 had the highest area under the curve (AUC) value for determining risk of GC in patients with PLGC and the six-RNA combination including CEBPA-AS1, INHBA-AS1, AK001058, UCA1, PPBP, and RGS18 had the highest AUC value for determining the risk of GC in patients with EGC. The results suggest the potential usefulness of noninvasive biomarkers for the molecular diagnosis of GC at earlier stages.

Scoring model for discriminating gastric cancer risk in patients with negative serum pepsinogen and anti‐Helicobacter pylori antibody results

The ABC test measures serum pepsinogen and anti-Helicobacter pylori IgG antibody levels to predict precancerous conditions in the stomach and gastric cancer. However, a limitation of this test is that the gastric cancer risk is not negligible in patients with a negative result. Based on their ABC results, 1157 patients were classified into Groups A (n=392), B (n=479), C (n=247), and D (n=39). In Group A, 24.2% of patients had atrophic gastritis and/or intestinal metaplasia and had thus been incorrectly assigned to Group A. Patients in Group A were then assigned to derivation (n=236) and validation (n=156) cohorts by 3:2 random sampling. Logistic regression analyses were performed to identify the factors discriminating between a correct (true) and incorrect (false) Group A classification. A 4-point discriminative model was constructed based on a high-negative H. pylori IgG antibody titer and the patient's age (50-64 and ≥65years). The areas under the receiver operating characteristic curve for the derivation and validation cohorts were 0.868 and 0.894, respectively. In the validation cohort, the addition of a discriminative model score ≥2 to the ABC method showed a similar accuracy for predicting gastric cancer risk compared with the ABC method alone (93.8% vs. 92.4%). The 4-point discriminative model may help identify patients with a normal serological test who are nonetheless at risk of developing gastric cancer.

Reduce Gastric Cancer Risk in Patients with Family History by Eradicating H. Pylori.

Dwight David Eisenhower Army Medical Center, Family Medicine Residency, Fort Gordon, GA The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department, the Army at large, or the Department of Defense.

The Relationship between Diabetes Mellitus and Gastric Cancer and the Potential Benefits of Metformin: An Extensive Review of the Literature.

The objective of this review is to summarize the findings of published research that investigated the relationship between diabetes mellitus and gastric cancer (GCa) and the potential benefits of metformin on GCa. Related literature has been extensively reviewed, and findings from studies investigating the relationship between diabetes mellitus and GCa suggest that hyperglycemia, hyperinsulinemia and insulin resistance are closely related to the development of GCa. Although not supported by all, most observational studies suggest an increased risk of GCa in patients with type 2 diabetes mellitus, especially in women and in Asian populations. Incidence of second primary malignancy diagnosed after GCa is significantly higher in diabetes patients. Diabetes patients with GCa may have more complications after gastrectomy or chemotherapy and they may have a poorer prognosis than patients with GCa but without diabetes mellitus. However, glycemic control may improve in the diabetes patients with GCa after receiving gastrectomy, especially after procedures that bypass the duodenum and proximal jejunum, such as Roux-en-Y gastric bypass or Billroth II reconstruction. The potential links between diabetes mellitus and GCa may involve the interactions with shared risk factors (e.g., obesity, hyperglycemia, hyperinsulinemia, insulin resistance, high salt intake, smoking, etc.), Helicobacter pylori (HP) infection, medications (e.g., insulin, metformin, statins, aspirin, proton pump inhibitors, antibiotics, etc.) and comorbidities (e.g., hypertension, dyslipidemia, vascular complications, heart failure, renal failure, etc.). With regards to the potential benefits of metformin on GCa, results of most observational studies suggest a reduced risk of GCa associated with metformin use in patients with T2DM, which can be supported by evidence derived from many in vitro and animal studies. Metformin use may also reduce the risk of HP infection, an important risk factor of GCa. In patients with GCa, metformin users may have improved survival and reduced recurrence. More studies are required to clarify the pathological subtypes/anatomical sites of GCa associated with type 2 diabetes mellitus or prevented by metformin, to confirm whether GCa risk can also be increased in patients with type 1 diabetes mellitus and to explore the possible role of gastric microbiota in the development of GCa.

Applications of machine learning models in the prediction of gastric cancer risk in patients after Helicobacter pylori eradication.

The risk of gastric cancer after Helicobacter pylori (H. pylori) eradication remains unknown. To evaluate the performances of seven different machine learning models in predicting gastric cancer risk after H. pylori eradication. We identified H. pylori-infected patients who had received clarithromycin-based triple therapy between 2003 and 2014 in Hong Kong. Patients were divided into training (n=64238) and validation sets (n=25330), according to period of eradication therapy. The data were used to construct seven machine learning models to predict risk of gastric cancer development within 5years after H. pylori eradication. A total of 26 clinical variables were input into these models. The performances were measured by the area under receiver operating characteristic curve (AUC) analysis. During a mean follow-up of 4.7years, 0.21% of H. pylori-eradicated patients developed gastric cancer. Of the seven machine learning models, extreme gradient boosting (XGBoost) had the best performance in predicting cancer development (AUC 0.97, 95%CI 0.96-0.98), and was superior to conventional logistic regression (AUC 0.90, 95% CI 0.84-0.92). With the XGBoost model, the number of patients considered at high risk of gastric cancer was 6.6%, with miss rate of 1.9%. Patient age, presence of intestinal metaplasia, and gastric ulcer were the heavily weighted factors used by the XGBoost. Based on simple baseline patient information, machine learning model can accurately predict the risk of post-eradication gastric cancer. This model could substantially reduce the number of patients who require endoscopic surveillance.

Nonaspirin nonsteroidal anti-inflammatory drugs and gastric cancer risk after Helicobacter pylori eradication: A territory-wide study.

Despite Helicobacter pylori (HP) eradication, individuals can still develop gastric cancer (GC). Prior studies have demonstrated that nonaspirin nonsteroidal anti-inflammatory drugs (NA-NSAIDs) reduce the risk of GC, but this may be caused by immortal time bias and failure to adjust for HP status. The objective of this study was to investigate whether NA-NSAIDs reduced the risk of GC in patients who undergo H. pylori eradication. Adult patients who had received clarithromycin-based triple therapy between 2003 and 2016 were identified from a territory-wide health care database. Exclusion criteria included prior GC or GC diagnosed <6 months after HP eradication, prior gastrectomy, gastric ulcer after HP eradication, and failure of triple therapy. Covariates included age, sex, prior peptic ulcer disease, other comorbidities, and concurrent medications (aspirin, proton pump inhibitors, statins, and metformin). To avoid immortal time bias, NA-NSAID use (≥90 days) was treated as a time-dependent variable in a multivariable Cox model (time-dependent analysis). Time-independent analysis was also performed. During a median follow-up of 8.9 years (interquartile range, 5.4-12.6 years), 364 of 92,017 patients (0.4%) who underwent HP eradication developed GC. NA-NSAID use was associated with a significant reduction in the risk of GC in time-fixed analysis (adjusted hazard ratio [aHR], 0.65; 95% CI, 0.47-0.90), but not in time-dependent multivariable analysis (aHR, 1.35; 95% CI, 0.97-1.87). Time-dependent subgroup analyses also did not indicate any significant association between NA-NSAID use and either cardia GC (aHR, 0.75; 95% CI, 0.27-2.06) or noncardia GC (aHR, 1.28; 95% CI, 0.83-1.98). NA-NSAID use was not associated with a reduced risk of GC among patients who underwent HP eradication. The chemopreventive effect of NA-NSAIDs observed in prior studies may have been confounded by immortal time bias.

Dye chromoendoscopy leads to a higher adenoma detection in the duodenum and stomach in patients with familial adenomatous polyposis.

Backround and study aims Duodenal cancer is the cancer most often seen in patients with familial adenomatous polyposis (FAP) who have undergone risk-reducing colonic surgery. Almost all patients with FAP eventually develop duodenal adenomas and risk for duodenal cancer is up to 12 % with poor prognosis. In addition, there is a rising concern regarding increased gastric cancer risk in patients with FAP. Our aim was to enhance polyp detection by using CE (CE) with the application of indigo carmine dye. Patient and methods We conducted a prospective, blinded study of patients with FAP undergoing endoscopic examination of the upper gastrointestinal tract. First, a standard white-light examination (WLE) was done followed by an examination performed by an endoscopist who was blinded to the previous examination, using chromoendoscopy (CE) (0.4 % indigo carmine dye). Results Fifty patients were included in the study. Using WLE, a median number of 13 adenomas (range 0–90) was detected compared to 23 adenomas/patient (range 0–150; P < 0.0001) detected after staining, leading to a higher Spigelman stage in 16 patients (32 %; P = 0.0003). CE detected significantly more larger adenomas (> 10 mm) than WLE (12 vs. 19; P = 0.0391). In the gastric antral region, a median number of 0 adenomas (range 0–6) before and 0.5 adenomas (range 0–7) after staining ( P = 0.0025) were detected. Conclusion This prospective endoscopic trial, to our knowledge the largest in patients with FAP, showed a significant impact of CE on adenoma detection and therapeutic management in the upper gastrointestinal tract. This leads to more intensive surveillance intervals.

Statins Were Associated with a Reduced Gastric Cancer Risk in Patients with Eradicated Helicobacter Pylori Infection: A Territory-Wide Propensity Score Matched Study.

Individuals may still develop gastric cancer even after Helicobacter pylori eradication. We aimed to investigate statin effect on gastric cancer development in H. pylori-eradicated subjects. All adult subjects who were prescribed clarithromycin-based triple therapy between 2003 and 2012 were identified in this retrospective cohort study utilizing a territory-wide electronic healthcare database. Patients were observed from index date of H. pylori therapy, and censored at gastric cancer diagnosis, death, or December 2015 (study end date). Statin use was defined as ≥180-day use after index date. Exclusion criteria included gastric cancer diagnosed within the first year after index date, previous gastric cancer or gastrectomy, and H. pylori treatment failure. Subdistribution hazard ratio (SHR) of gastric cancer with statins was calculated by competing risk regression with propensity score (PS) analysis matching 19 variables (age, sex, comorbidities, and other drug usage, including proton pump inhibitors, nonsteroidal anti-inflammatory drugs, aspirin, cyclooxygenase-2 inhibitors, and metformin). During a median follow-up of 7.6 years (interquartile range = 5.1-10.3), 169 (0.27%) of 63,605 patients developed gastric cancer at an incidence rate of 3.5 per 10,000 person-years. Among 22,870 PS-matched subjects, statins were associated with a lower gastric cancer risk (SHR = 0.34; 95% confidence interval, 0.19-0.61), in a duration- and dose-response manner (P trend < 0.05). Statins were associated with a lower gastric cancer risk in a duration- and dose-response manner among H. pylori-eradicated patients. This study provides evidence on the additional benefits of statins as chemopreventive agents against gastric cancer among H. pylori-eradicated patients.

The Influence of Family History on Stage and Survival of Gastric Cancer According to the TGFB1 C-509T Polymorphism in Korea.

Background/AimsThe survival rate of gastric cancer (GC) is known to be higher in patients with a family history (FH) of GC. There is an association between a polymorphism in the transforming growth factor-β1 (TGFB1) gene and the risk of GC in patients with first-degree relatives with GC. This study was performed to investigate whether a FH affects GC outcomes according to the TGFB1 C-509T polymorphism.MethodsTGFB1 was genotyped by the polymerase chain reaction-restriction fragment length polymorphism method in 1,143 GC patients, including 216 patients (18.9%) with first-degree relatives with GC.ResultsThe proportion of stage I–II GCs was significantly higher in patients with a FH than in those without a FH of GC (83.8 vs 74.9%, p=0.005). The association between a FH of GC and stage I–II GC was not significant in subgroups divided based on the TGFB1 C-509T polymorphism and sex. A FH did not affect the overall survival rate of GC in patient with all stages and each stage. The overall survival rates were not significantly different between patients with the CC and CT/TT genotypes of the TGFB1-509 polymorphism.ConclusionsPatient with a FH of GC had lower cancer stage (I–II) at diagnosis than those without a FH of GC, but there was no significant difference in overall survival between the patients with and without a FH of GC. A FH did not influence the tumor stage or overall survival in patients stratified by the presence of the TGFB1 C-509T polymorphism.

Long Noncoding RNA HOX Transcript Antisense RNA Gene rs17720428 Single Nucleotide Polymorphism Is Associated with Gastric Cancer Risk and Prognosis.

Objective: To study the correlation between the long noncoding RNA HOX transcript antisense RNA (HOTAIR) gene rs17720428 single nucleotide polymorphism (SNP) and gastric cancer risk and prognosis. Methods: A case-control study was designed to assess the correlation between the HOTAIR rs17720428 SNP and gastric cancer risk in the Chinese Han population. The genotype of the HOTAIR rs17720428 locus was analyzed in 245 patients with gastric cancer and 245 healthy control subjects by Sanger sequencing. Results: The gastric cancer risk in patients with a G allele at the HOTAIR rs17720428 locus was 1.59 times higher than that in patients with a T allele (95% confidence interval [CI]: 1.16-2.17, p < 0.01). This SNP of HOTAIR rs17720428 locus was associated with an increased risk for developing gastric cancer in males (male: adjusted odds ratio = 1.60, 95% CI = 1.02-2.52, p = 0.04). Patients with the GG genotype at the HOTAIR rs17720428 locus had the lowest overall survival (OS) (16.4 months), followed by those with the TG (19.3 months) and TT (24.2 months) genotypes. The differences in OS were statistically significant among the different genotypes (p = 0.003). Conclusion: The HOTAIR rs17720428 SNP is correlated with the risk and prognosis of gastric cancer in the Chinese Han population. The presence of a G allele at this locus increases the risk of gastric cancer among males.

Diabetes Increases Risk of Gastric Cancer After Helicobacter pylori Eradication: A Territory-Wide Study With Propensity Score Analysis.

Whether diabetes mellitus (DM) increases risk of gastric cancer (GC) remains controversial because of inadequate adjustments for important risk factors, including Helicobacter pylori (HP) infection status, concomitant medication use, and cancer site. We investigated whether type 2 DM increased risk of GC in patients after they received treatment for HP infection. This was a territory-wide cohort study of patients aged ≥45 years who had received clarithromycin-based triple therapy for HP infection between 2003 and 2012 in Hong Kong. Data were retrieved from a public electronic health database. Observation started from receipt of therapy for HP infection to GC diagnosis, death, or the end of the study (December 2015). Exclusion criteria included type 1 DM, GC diagnosed within the 1st year of HP therapy, prior GC or gastrectomy, and retreatment for HP infection. The adjusted hazard ratio (aHR) of GC with type 2 DM was calculated by using a Cox model that adjusted for 20 covariates (age, sex, comorbidities, and medications) through propensity score regression. During a median follow-up of 7.1 years (interquartile range 4.8-9.3 years), 153 of 46,460 patients (0.33%) developed GC at a median age of 72.4 years. Type 2 DM was associated with an increased risk of GC (aHR 1.73 [95% CI 1.08-2.79]). Stratified analysis showed an increase in risk for cardia cancer only (aHR 3.40 [95% CI 1.45-7.97]) and in those with suboptimal DM control (time-weighted mean HbA1c ≥6.0% [42 mmol/mol]; aHR 1.68 [95% CI 1.07-2.63]). Type 2 DM is associated with an increased risk of GC among patients in whom HP was eradicated, in particular gastric cardia cancer and in those with suboptimal DM control.

Antipsychotic use is inversely associated with gastric cancer risk: A nationwide population-based nested case-control study.

ObjectiveThe association between antipsychotic use and gastric cancer risk remains unclear. Therefore, this study aimed to determine the association between antipsychotic exposure and the incidence of gastric cancer.MethodsUsing a nested case‐control design, a total of 34 470 gastric cancer patients and 163 430 nongastric cancer controls were identified from Taiwan's National Health Insurance Research Database between 1 January 1997 and 31 December 2013. We analyzed the data using a conditional logistic regression model to adjust for possible confounding variables.ResultsAntipsychotic use was independently inversely associated with gastric cancer risk after controlling for potential confounding factors including income, urbanization, medications, physical and medical illness, aspirin use, nonsteroidal anti‐inflammatory drug use and triple therapy. In addition, dose‐dependent trends against gastric cancer risk were also shown with individual antipsychotic compounds including thioridazine, haloperidol, sulpiride, clozapine, olanzapine, quetiapine, amisulpride, and risperidone. A sensitivity analysis showed that second‐generation antipsychotics had significant dose‐dependent effects in reducing the risk of gastric cancer risk in patients with and without peptic ulcer disease.ConclusionsAntipsychotic use was inversely associated with gastric cancer risk, and dose‐dependent effects against gastric cancer were also seen with several individual antipsychotic compounds.

Combined Gastric and Colorectal Cancer Screening-A New Strategy.

Background: Our aim was to evaluate the feasibility of a serological assessment of gastric cancer risk in patients undergoing colonoscopy in countries with low-to-moderate incidence rates. Methods: Serum samples were prospectively collected from 453 patients (>50 years old) undergoing colonoscopies. Of these, 279 (61.6%) also underwent gastroscopy to correlate the results for serum pepsinogen I and II (sPG-I and sPG-II), sPG-I/II ratio, and anti-H. pylori antibodies with gastric histopathology findings (graded according to the updated Sydney classification and the Operative Link of Gastritis Assessment (OLGA) and the Operative Link for Gastric Intestinal Metaplasia assessment (OLGIM) systems). Results: H. pylori was found in 85 patients (30.5%). Chronic atrophic gastritis was diagnosed in 89 (31.9%) patients. High-risk OLGA (III–IV) stages were present in 24 patients, and high-risk OLGIM stages were present in 14 patients. There was an inverse correlation of sPG-I with the degree of atrophy and intestinal metaplasia (IM), as well as with the respective OLGA (r = −0.425; p < 0.001) and OLGIM (r = −0.303; p < 0.001) stages. A pathological sPG-I result was associated with a relative risk (RR) of 12.2 (95% confidence interval: 6.29–23.54; p < 0.001) for gastric preneoplastic changes. Conclusions: The assessment of serum pepsinogen allows the identification of patients at increased risk of gastric cancer. A prevention strategy of combining a screening colonoscopy with a serological screening for preneoplastic gastric changes should be considered in the general population.