Metachronous Gastric Carcinoma Research Articles

Gastric Adenoma: A High Incidence Rate of Developing Carcinoma and Risk of Metachronous Gastric Cancer according to Long-Term Follow-Up

Introduction: Gastric adenomas are histologically defined as benign epithelial tumors. While some of them remain adenomas for a long time, others progress to carcinomas. However, long-term outcomes of such cases are not entirely clear. Here, we explored the risk factors and incidence of developing carcinoma from gastric adenoma as well as metachronous gastric cancer. Methods: This study was conducted at a facility that adopted a follow-up strategy for gastric adenoma. Lesions histologically diagnosed as gastric intestinal-type adenomas between January 2004 and December 2016 were analyzed. Clinicopathological data were collected from patients’ medical records, and histological changes from adenoma to carcinoma during endoscopic follow-up and risk factors of cancer development were evaluated. Results: This study involved 409 lesions from 376 patients. The analysis of the development of gastric cancer from adenoma and metachronous gastric cancer was ultimately performed for 282 lesions from 258 patients and 269 lesions from 246 patients, respectively, due to different follow-up periods. The 5-year rate of carcinoma development was 34.0%. Risk factors for carcinoma development upon multivariate analysis were lesion size ≥15 mm and morphological depression. All cases with both factors developed gastric carcinoma, and 50.5% of those with either factor developed carcinoma within 5 years. Gastric adenoma was accompanied by metachronous gastric cancer in 1.5% of the patients annually. The only risk factor for metachronous gastric carcinoma was primary adenoma progressing to carcinoma during the follow-up period. Discussion/Conclusion: Given the high rate of carcinoma development in patients with risk factors, resection of gastric adenoma should be considered during the initial examination. Careful observation and follow-up should also be conducted to detect not only changes in the primary adenoma but also the occurrence of metachronous carcinoma, especially in cases of adenoma progressing to carcinoma.

Fetal-type Glycogen Phosphorylase Expression in Intestinal Metaplasia as a Predictor of the Development of Gastric Cancer

Glycogen phosphorylase (GP; EC 2.4.1.1) plays a central role in the mobilization of carbohydrate reserves in a wide variety of organs and tissues. There are three major isoforms of mammalian GP; i.e., the muscle, liver, and brain isoforms. The physiological roles of muscle and liver GP are to provide fuel for energy production (to produce the energy required for muscle contraction) and to ensure a constant supply of glucose to extra hepatic tissues, respectively. However, the physiological role of brain GP (BGP) is poorly understood. It has been demonstrated that BGP is the major isoform of GP found in fetal tissue and tumor tissue, and BGP is identical to fetal-type GF (FGP). We have demonstrated that the significant enzymatic activity of FGP in the gastric carcinoma and proliferating cells of particular Intestinal Metaplasia (IM). We studied 136 specimens with gastric carcinoma and the adjacent IM using specific anti-FGP antibody. FGP was expressed in 80% of the intestinal type and 19% of the diffuse type of carcinoma and in 88% and 42% in the generative zone of IM adjacent to each type of cancer foci, respectively. The proportion of the positivity of FGP expression in the cancer and IM was significantly greater in intestinal type carcinoma than in diffuse type. In addition, according to the proliferating cell nuclear antigen labeling index analysis, IM with FGP expression (FGP-IM) were significantly higher in a proliferating state than in IM without FGP, and some of them were co-expressed accumulated p53 in the generative cells. These data indicate that FGP could be one of the fetal biomarkers and FGP-IM could be a premalignant lesion of intestinal type adenocarcinoma. We conducted another study to investigate the incidence of FGP-IM in gastric biopsy specimens and to identify FGP-IM as a predictor of the coexistence of accessory carcinoma and/or metachronous carcinoma. Eight endoscopic biopsy specimens of methylene blue-positive mucosa of the stomach were obtained from the patients with multiple gastric carcinomas (n=14), a single carcinoma (n=25) and atrophic gastritis (n=20), examined the incidence of FGP-IM. FGP positivity was 93.3% in the multiple carcinomas and 80.0% in the single carcinomas. The incidences of FGP-IM in the stomachs with multiple carcinomas, single carcinoma and atrophic gastritis were 83.2 ± 22.8%, 36.5 ± 41.3% and 7.1 ± 18.0%, respectively. The incidence of FGP-IM was significantly higher in the stomachs with multiple carcinomas than in those with a single carcinoma or atrophic gastritis. It is suggested that the frequent appearance of FGP-IM reflects the high potential of carcinogenesis of intestinal type gastric carcinoma and FGP-IM could be a predictive indicator of metachronous gastric carcinoma. Recently, there are increasing opportunities where endoscopic and laparoscopic local treatments are applied for the early gastric carcinoma, therefore, it is significantly important to identify the high-risk group of metachronous recurrence of gastric carcinoma. FGP could serve as a potential predictor of the risk of the development of multiple and/or metachronous carcinomas. It might be possible to follow-up new lesions using this method, and follow-up studies would provide better information on whether FGP-IM positivity is a good predictor of metachronous recurrence after local treatment for gastric cancer.

Risk factors for metachronous gastric carcinoma development after endoscopic resection of gastric dysplasia: Retrospective, single-center study.

AIMTo determine the gastric adenocarcinoma (GAC) occurrence rate and related factors, we evaluated the follow-up results of patients confirmed to have gastric dysplasia after endoscopic resection (ER).METHODSWe retrospectively analyzed the medical records, endoscopic examination records, endoscopic procedure records, and histological records of 667 cases from 641 patients who were followed-up for at least 12 mo, from among 1273 patients who were conformed to have gastric dysplasia after Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of gastric mucosal lesions between January 2007 and August 2013 at the Chungnam National University Hospital.RESULTSThe mean follow-up period was 33.8 mo, and the median follow-up period was 29 mo (range: 12-87). During the follow-up period, the occurrence of metachronous GAC was 4.0% (27/667). The mean and median interval periods between the occurrence of metachronous GAC and endoscopic treatment of gastric dysplasia were 36.3 and 34 mo, respectively (range: 16-71). The factors related to metachronous GAC occurrence after ER for gastric dysplasia were male sex (5.3% vs 1.0%), open-type atrophic gastritis (9.5% vs 3.4%), intestinal metaplasia (6.8% vs 2.4%), and high-grade dysplasia (HGD; 8.4% vs 3.2%). Among them, male sex [OR: 5.05 (1.18-21.68), P = 0.029], intestinal metaplasia [OR: 2.78 (1.24-6.23), P = 0.013], and HGD [OR: 2.70 (1.16-6.26), P = 0.021] were independent related factors in multivariate analysis. Furthermore, 24 of 27 GAC cases (88.9%) occurred at sites other than the previous resection sites, and 3 (11.1%) occurred at the same site as the previous resection site.CONCLUSIONMale sex, intestinal metaplasia, and HGD were significantly related to the occurrence of metachronous GAC after ER of gastric dysplasia, and most GACs occurred at sites other than the previous resection sites.

PD-018 Risk factors for metachronous gastric carcinoma development after endoscopic resection of gastric dysplasia

PD-018 Risk factors for metachronous gastric carcinoma development after endoscopic resection of gastric dysplasia

Usefulness of Helicobacter pylori eradication for precancerous lesions of the gastric remnant.

Secondary stomach cancer in lesions of the remnant stomach occurs relatively soon after distal gastrectomy using the Billroth I reconstruction procedure. Prophylactic eradication of Helicobacter pylori after endoscopic resection of early gastric cancer should be used to prevent the development of metachronous gastric carcinoma. However, the effect of H. pylori eradication on the gastric remnant has not been clearly determined. Eight patients who were H. pylori-positive after distal gastrectomy for primary gastric cancer underwent eradication therapy and were followed by endoscopy for 9 years. Upper gastroenteroscopy series were done before and at 1, 3, 5, 7 and 9 years after eradication, and biopsy specimens were taken from the lesser and greater curvatures, respectively. Histological changes, including chronic inflammation, activity, atrophy, and intestinal metaplasia, were evaluated using the updated Sydney system. Successful eradication was confirmed using the urea breath test in all eight patients. Chronic inflammation scores were improved after eradication at both the lesser (mean scores ± SD: before eradication, 2.9±0.5; 1 year after, 2.3±0.4; 3 years, 1.8±0.3; 5 years, 1.5±0.3; 7 years, 1.3±0.3; and 9 years, 1.0±0.3) and greater curvatures (before, 2.9±0.4; 1 year after, 1.9±0.3; 3 years, 1.4±0.4; 5 years, 1.3±0.3; 7 years, 1.1±0.2; and 9 years, 0.6±0.3). Atrophy scores improved more quickly after eradication than chronic inflammation scores at both the lesser (before, 2.4±0.5; 1 year after, 1.8±0.4; 3 years, 0.8±0.3; 5 years, 0.3±0.1; 7 years, 0.0; and 9 years, 0.0) and greater curvatures (before, 2.2±0.4; 1 year after, 1.3±0.3; 3 years, 0.5±0.3; 5 years, 0.0; 7 years, 0.0; and 9 years, 0.0). No secondary stomach cancers were found on endoscopy. Undergoing H. pylori eradication improved possible precancerous lesions of the gastric remnant among patients who had undergone distal gastrectomy. Prophylactic H. pylori eradication in the gastric remnant may be useful in preventing the development of metachronous gastric carcinoma.

Prediction of Helicobacter pylori Status by Conventional Endoscopy, Narrow‐Band Imaging Magnifying Endoscopy in Stomach after Endoscopic Resection of Gastric Cancer

To reduce the incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer, Helicobacter pylori eradication therapy has been endorsed. It is not unusual for such patients to be H. pylori negative after eradication or for other reasons. If it were possible to predict H. pylori status using endoscopy alone, it would be very useful in clinical practice. To clarify the accuracy of endoscopic judgment of H. pylori status, we evaluated it in the stomach after endoscopic submucosal dissection (ESD) of gastric cancer. Fifty-six patients treated by ESD were enrolled. The diagnostic criteria for H. pylori status by conventional endoscopy and narrow-band imaging (NBI)-magnifying endoscopy were decided, and H. pylori status was judged by two endoscopists. Based on the H. pylori stool antigen test as a diagnostic gold standard, conventional endoscopy and NBI-magnifying endoscopy were compared for their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Interobserver agreement was assessed in terms of κ value. Interobserver agreement was moderate (0.56) for conventional endoscopy and substantial (0.77) for NBI-magnifying endoscopy. The sensitivity, specificity, PPV, and NPV were 0.79, 0.52, 0.70, and 0.63 for conventional endoscopy and 0.91, 0.83, 0.88, and 0.86 for NBI-magnifying endoscopy, respectively. Prediction of H. pylori status using NBI-magnifying endoscopy is practical, and interobserver agreement is substantial.

Eradication of Helicobacter pylori After Endoscopic Resection of Gastric Tumors Does Not Reduce Incidence of Metachronous Gastric Carcinoma

It is not clear whether eradication of Helicobacter pylori infection reduces the risk for metachronous gastric carcinoma. We performed a prospective, randomized, open-label trial of the effects of H pylori eradication on the incidence of metachronous carcinoma after endoscopic resection of gastric tumors. From April 2005 through February 2011 there were 901 consecutive patients with H pylori infection who had been treated with endoscopic resection for gastric dysplasia or cancer and who were assigned randomly to groups given therapy to eradicate the infection (n = 444) or no therapy (controls, n = 457). The eradication group received 20 mg omeprazole, 1 g amoxicillin, and 500 mg clarithromycin twice daily for 1 week. Patients underwent endoscopic examination 3, 6, and 12 months after treatment, and then yearly thereafter. The primary outcome was development of metachronous gastric carcinoma. During a median follow-up period of 3 years, 10 patients who received H pylori eradication and 17 controls developed metachronous carcinoma; this difference was not significant (P = .15). The incidence of metachronous carcinoma between the 2 groups did not differ significantly at 1, 2, 3, and 4 years after administration of the therapy. There were no significant differences in the development of metachronous carcinoma among patients who were positive (n = 16) or negative (n = 11) for H pylori infection (P = .32). In this prospective trial, eradication of H pylori after endoscopic resection of gastric tumors did not significantly reduce the incidence of metachronous gastric carcinoma. ClinicalTrials.gov Number: NCT01510730.

11 The Rising Incidence of Esophageal Adenocarcinoma is Not Accompanied With an Increase in Mortality: Results of a Population-Based Cohort Study

Background:It has been proved thatH. pylori eradication prevents the incidence of metachronous gastric cancer after endoscopic resection (ER) of primary early gastric cancer during short-term follow-up. However, it has not been clarified whether preventive effect of H. pylori eradication for gastric cancer continues in the long term. To determine the long-term effect of H. pylori eradication on the development of gastric cancer, a follow-up study of a JGSG trial (Lancet 2008; 372: 392-7) was conducted. Methods: In this multi-center, openlabel, randomized controlled trial, 544 patients who received ER of early gastric cancer were randomly assigned to the H pylori eradication group (n=272) or to the control group (n= 272). Endoscopy was performed every year after randomization to evaluate metachronous cancer. Diagnosis of a new gastric cancer at another site of the stomach was defined as primary endpoint. Metachronous cancers were confirmed through histological examination. The frequency of metachronous cancer in the eradication group was compared to that in the control group. Results: There were no significant differences between eradication and control groups in baseline characteristics. The follow-up period was 10 years at maximum. After three years of follow-up, metachronous gastric cancer was detected in 32 participants. In the end, metachronous gastric carcinoma had developed in 22 patients in the eradication group and 43 in the control group. In the modified intention-to-treat population, including patients with at least one post-randomization assessment of tumor status and adjusting for loss to follow-up (255 patients in the eradication group, 250 in the control group), the hazard ratio for metachronous gastric carcinoma was 0.497 (95% CI 0.2970.831; p=0.008). The eradication group and the control group showed no difference in characteristics of metachronous cancer. Conclusions: This study showed that H. pylori eradication prevented the development of metachronous gastric cancers after ER during long-term follow-up.

9 Long-Term Follow-up Study About Preventive Effect of H. pylori Eradication for the Incidence of Metachronous Gastric Cancer After Endoscopic Resection of Primary Early Gastric Cancer

Background:It has been proved thatH. pylori eradication prevents the incidence of metachronous gastric cancer after endoscopic resection (ER) of primary early gastric cancer during short-term follow-up. However, it has not been clarified whether preventive effect of H. pylori eradication for gastric cancer continues in the long term. To determine the long-term effect of H. pylori eradication on the development of gastric cancer, a follow-up study of a JGSG trial (Lancet 2008; 372: 392-7) was conducted. Methods: In this multi-center, openlabel, randomized controlled trial, 544 patients who received ER of early gastric cancer were randomly assigned to the H pylori eradication group (n=272) or to the control group (n= 272). Endoscopy was performed every year after randomization to evaluate metachronous cancer. Diagnosis of a new gastric cancer at another site of the stomach was defined as primary endpoint. Metachronous cancers were confirmed through histological examination. The frequency of metachronous cancer in the eradication group was compared to that in the control group. Results: There were no significant differences between eradication and control groups in baseline characteristics. The follow-up period was 10 years at maximum. After three years of follow-up, metachronous gastric cancer was detected in 32 participants. In the end, metachronous gastric carcinoma had developed in 22 patients in the eradication group and 43 in the control group. In the modified intention-to-treat population, including patients with at least one post-randomization assessment of tumor status and adjusting for loss to follow-up (255 patients in the eradication group, 250 in the control group), the hazard ratio for metachronous gastric carcinoma was 0.497 (95% CI 0.2970.831; p=0.008). The eradication group and the control group showed no difference in characteristics of metachronous cancer. Conclusions: This study showed that H. pylori eradication prevented the development of metachronous gastric cancers after ER during long-term follow-up.

10 PA32540, a Tablet Containing Enteric-Coated (EC) Aspirin 325 mg and Unbuffered Immediate-Release Omeprazole 40 mg, Provides Percent Time Gastric pH >4 Significantly Less Than EC Omeprazole 40 mg, but With Faster Onset and Less Exposure to Omeprazole

Background:It has been proved thatH. pylori eradication prevents the incidence of metachronous gastric cancer after endoscopic resection (ER) of primary early gastric cancer during short-term follow-up. However, it has not been clarified whether preventive effect of H. pylori eradication for gastric cancer continues in the long term. To determine the long-term effect of H. pylori eradication on the development of gastric cancer, a follow-up study of a JGSG trial (Lancet 2008; 372: 392-7) was conducted. Methods: In this multi-center, openlabel, randomized controlled trial, 544 patients who received ER of early gastric cancer were randomly assigned to the H pylori eradication group (n=272) or to the control group (n= 272). Endoscopy was performed every year after randomization to evaluate metachronous cancer. Diagnosis of a new gastric cancer at another site of the stomach was defined as primary endpoint. Metachronous cancers were confirmed through histological examination. The frequency of metachronous cancer in the eradication group was compared to that in the control group. Results: There were no significant differences between eradication and control groups in baseline characteristics. The follow-up period was 10 years at maximum. After three years of follow-up, metachronous gastric cancer was detected in 32 participants. In the end, metachronous gastric carcinoma had developed in 22 patients in the eradication group and 43 in the control group. In the modified intention-to-treat population, including patients with at least one post-randomization assessment of tumor status and adjusting for loss to follow-up (255 patients in the eradication group, 250 in the control group), the hazard ratio for metachronous gastric carcinoma was 0.497 (95% CI 0.2970.831; p=0.008). The eradication group and the control group showed no difference in characteristics of metachronous cancer. Conclusions: This study showed that H. pylori eradication prevented the development of metachronous gastric cancers after ER during long-term follow-up.

Gastric cancer in the reconstructed gastric tube after radical esophagectomy: A single-center experience

Metachronous gastric carcinoma arising in a gastric tube used for esophageal reconstruction has been occasionally encountered in long-term survivors of esophageal cancer. This study investigated 10 cases of gastric tube cancer in order to clarify the characteristics and the outcome of these patients. Four hundred and seventy-one patients underwent a radical esophagectomy at Kyushu University Hospital between 1989 and 2003. There were 10 cases of gastric tube cancer after an esophagectomy. The interval between the esophagectomy and the development of the gastric tube cancer ranged from 1.1 to 7 years. There was no peak for the incidence of gastric tube cancer. In 6 of 10 cases of gastric tube cancer, endoscopic or surgical resection were performed for the treatment; however, chemotherapy was administered to the other 4 cases for several reasons. The prognosis of patients who underwent resection was better than that of the other patients. Frequent endoscopic examinations are therefore important even several years after performing an esophagectomy, since the risk of gastric tube cancer is higher than the risk of a recurrence of esophageal cancer several years after an esophagectomy. Only an early diagnosis permits a less invasive and appropriate approach for the treatment of gastric tube cancer.

Two Cases of Early Carcinoma of a Reconstructed Gastric Tube after Esophagectomy Treated Extendedly with Endoscopic Submucosal Dissection

.Yamaguchi Med J (Yamaguchi Igaku)53:103-107,2004 33) Motoyama S,Mori K,Maruyama K,Sato Y,Hayashi K,Usami S,Suzuki H,Ogawa J:S-1 chemotherapy for cancer of the gastric tube used for esophageal reconstruction following surgery for esophageal cancer(in Japanese with English abstract).Jpn J Cancer Chemother (Gan to Kagaku Ryoho)34:2287-2290,2007 34) Yamasawa K,Shimizu T,Shimosato A,Mihara F,Tokuhara M,Hashimoto M,Saito Y,Endo H,Tamegai Y: Two cases of cancer in the reconstructed gastric tube after resection of esophageal cancer-an analysis of 7 cases in our hospital-(in Japanese with English abstract).Jpn J Gastroenterol(Nippon Shokakibyo Gakkai Zasshi)106: 793-799,2009 35) Koyanagi K,Kanai T,Nakagawa M,Nagase T,Tawara H,Tabuchi S,Koyama I:Endoscopic treatment for metachronous early gastric carcinoma in a reconstructed gastric tube after radical operation of esophageal carcinoma -summary of 29 reported cases-(in Japanese).Prog Dig Endosc 74:24-27,2009 36) Suzumura K,Oh K,Iimuro Y,Yamanaka J,Kuroda N,Hirano T,Okada T,Uyama N,Satake M,Fujimoto J:A case of gastric tube cancer 4 years after esophagectomy for thoracic esophageal cancer treated by endoscopic mucosal resection (in Japanese with English abstract).JJSC (Nihon Gekakei Rengo Gakkaishi)34:582-586,2009 (2010.10.21received;2010.12.13accepted) 88 Shinshu Med J Vol.59 Koide.Suzuki.Akamatsu et al.

Primary gastric Hodgkin lymphoma and metachronous early gastric carcinoma: a case report

Primary Gastric Hodgkin lymphoma is seen very rarely. Primary gastric Hodgkin lymphoma and gastric carcinoma in same patient is very very rare entity. Almost all of the primary gastric lymphoma cases are non-Hodgkin lymphoma type. We report the case of 45-year-old man with 3-month history of abdominal pain and weight loss. Upper gastrointestinal endoscopic examination revealed an ulcerated polypoid mass on greater curve of stomach and histopathological examination of biopsy showed adenocarcinoma. After near total gastrectomy, gastric Hodgkin lymphoma diagnosis was made, and postoperative 4 courses of doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) regimen were administered, and then total 3,600 cGy radiotherapy was delivered. After 7 years, during control examination, early gastric carcinoma was diagnosed. Our case is very rare entity of gastric Hodgkin lymphoma and metachronous gastric carcinoma. This case also shows the importance of follow-up of patients not only for the relapse of primary disease but also for the development of secondary malignancy which can be diagnosed at early curable stage.

Strategies for gastric cancer in the modern era

Gastric cancer is one of the most common neoplasms in Japan, and it is also the second leading cause of cancer-related deaths worldwide. Nowadays, infection with Helicobacter pylori (H. pylori) is a known risk factor for the development of gastric cancer. Therefore, gastric cancer should be considered as an infectious disease, and in fact, prophylactic eradication of H. pylori may prevent the development of metachronous gastric carcinoma. Before the role of H. pylori was understood, a different approach was used. Recently even after the cancer has developed, some newer therapeutic approaches have been pursued. These newer treatments have been summarized as "minimally invasive therapies" and use endoscopic or laparoscopic techniques. In addition, robotic approaches are being developed that seem to hold a great potential to change the surgical approach. Since basic understanding and treatment of the disease have both changed significantly over the last decade, we present a review of current advances in gastric cancer research and therapy.

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

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

“Adjuvant” Therapy after Endoscopic Mucosal Resection of Early Gastric Cancer

“Adjuvant” Therapy after Endoscopic Mucosal Resection of Early Gastric Cancer

Endoscopic Treatment for Metachronous Early Gastric Carcinoma in a Reconstructed Gastric Tube after Radical Operation of Esophageal Carcinoma -Summary of 29 Reported Cases-

食道癌手術成績の向上に伴い再建胃管の異時性胃癌症例は増加しており，今後，早期胃管癌に対する内視鏡的診断および治療はさらに重要になるものと考えられる。そこで早期胃管癌の内視鏡的治療報告例29例をまとめ，その臨床病理学的特徴を検討した。発見動機はほとんどが術後の定期的内視鏡検査（23例，79％）で，胃管癌発見までの期間は18～221カ月（中央値54カ月）であった。病変占居部位は幽門側に多く，高分化型腺癌の頻度が高く，肉眼型は隆起型が多いなどの特徴を認めた。内視鏡的粘膜切除術が25例（86％）に施行されていたが，一括切除例は6例であった。手術侵襲を考慮した適応拡大とともに胃管作成に伴う形態変化や瘢痕なども一括切除を困難にしている原因と考えられた。内視鏡的粘膜切除術後の再発例の報告は自験例以外にないが，自験例は再発部位にアルゴンプラズマ凝固法を施行し局所コントロールに有効であった。 食道癌術後の早期胃管癌発見を目的とした定期的上部消化管内視鏡検査は重要であり，胃管癌の発見期間を考慮すると食道癌術後5年以上経過例にも必要であると考えられた。また，早期胃管癌に対する内視鏡的治療は安全性も高く低侵襲であり，積極的に施行しうると考えられた。

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

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

Eradication of H. pylori after endoscopic resection for early gastric cancer reduced risk for metachronous gastric cancer

Source Citation 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: a...

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

The relation between Helicobacter pylori infection and gastric cancer has been proven in epidemiological studies and animal experiments. Our aim was to investigate the prophylactic effect of H pylori eradication on the development of metachronous gastric carcinoma after endoscopic resection for early gastric cancer. In this multi-centre, open-label, randomised controlled trial, 544 patients with early gastric cancer, either newly diagnosed and planning to have endoscopic treatment or in post-resection follow-up after endoscopic treatment, were randomly assigned to receive an H pylori eradication regimen (n=272) or control (n=272). Randomisation was done by a computer-generated randomisation list and was stratified by whether the patient was newly diagnosed or post-resection. Patients in the eradication group received lansoprazole 30 mg twice daily, amoxicillin 750 mg twice daily, and clarithromycin 200 mg twice daily for a week; those in the control group received standard care, but no treatment for H pylori. Patients were examined endoscopically at 6, 12, 24, and 36 months after allocation. The primary endpoint was diagnosis of new carcinoma at another site in the stomach. Analyses were by intention to treat. This trial is registered with the UMIN Clinical Trials Registry, number UMIN000001169. At 3-year follow-up, metachronous gastric carcinoma had developed in nine patients in the eradication group and 24 in the control group. In the full intention-to-treat population, including all patients irrespective of length of follow-up (272 patients in each group), the odds ratio for metachronous gastric carcinoma was 0.353 (95% CI 0.161-0.775; p=0.009); in the modified intention-to-treat population, including patients with at least one post-randomisation assessment of tumour status and adjusting for loss to follow-up (255 patients in the eradication group, 250 in the control group), the hazard ratio for metachronous gastric carcinoma was 0.339 (95% CI 0.157-0.729; p=0.003). In the eradication group, 19 (7%) patients had diarrhoea and 32 (12%) had soft stools. Prophylactic eradication of H pylori after endoscopic resection of early gastric cancer should be used to prevent the development of metachronous gastric carcinoma. Hiroshima Cancer Seminar Foundation.