Gastric Cancer with Submucosal Invasion after Successful Helicobacter pylori Eradication: A Propensity Score-Matched Analysis of Patients with Annual Patient Endoscopic Survey

Abstract

Background and Aim: The incidence of gastric cancer occurring after successful Helicobacter pylori eradication has been increasing. We aimed to clarify the influence of eradication therapy on the ability to diagnose early gastric cancer after successful H. pylori eradication in patients who underwent annual endoscopic screening. Methods: A total of 220 patients (179 men; mean age 71.0 years) had differentiated-type early gastric cancer that was discovered through annual endoscopic screening. Patients were categorized into 2 groups: the H. pylori-eradicated group (n = 81) and the non-eradicated control group (n = 139). After matching patients by propensity scores, we retrospectively analyzed the clinicopathological characteristics of 162 patients (81 patients in each group). Furthermore, we compared the characteristics of gastric cancer with submucosal invasion between the 2 groups. Results: The prevalence of early gastric cancer with submucosal invasion was significantly higher in the eradicated group than in the control group, both before propensity score matching (16.0 vs. 7.2%, respectively; p = 0.038) and after propensity score matching of 81 pairs (16.0 vs. 4.9%, respectively; p = 0.021). In the comparative analysis of gastric cancer with submucosal invasion, there was no difference between the 2 groups with respect to factors influencing the ability to diagnose its presence endoscopically. Conclusion: H. pylori eradication therapy increased the prevalence of differentiated-type gastric cancer with submucosal invasion despite patients’ completion of annual endoscopic screening after eradication.

Characteristics and Early Diagnosis of Gastric Cancer Discovered after Helicobacter pylori Eradication

“…The prevalence of early gastric cancer with submucosal invasion was significantly higher in the eradicated group than in the control group after propensity score matching (16.0% vs 4.9%, respectively; p=0.021) ( Table 1). 45,46 We could not detect a statistically significant difference in any features, including sex, age, previous cancer history, location, macroscopic type, and tumor size between two groups. 46 H. pylori eradication therapy increased the prevalence of differentiated-type gastric cancer with submucosal invasion despite patients' completion of annual endoscopic screening after eradication.…”

Near-focus magnification and second-generation narrow-band imaging for early gastric cancer in a randomized trial

“…Fifth, we did not collect the data concerning H. pylori status in this study. Several studies have reported that the diagnosis of EGC may be affected by H. pylori eradication, such as the increase of ''gastritis-like'' EGC [34], the appearance of characteristic epithelium with low-grade atypia on the surface of gastric cancer [35,36] and increased prevalence of differentiated-type GC with submucosal invasion [37]. There may be a possibility that EGC were missed among post-eradication patients during the protocol examination.…”

Clinicopathological Characteristics and Endoscopic Features of Early Gastric Cancers Diagnosed After Helicobacter pylori Eradication

“…Recently, several studies reported that there were cases of submucosal invasive EGCs after H. pylori eradication. In 162 patients with H. pylori eradication and non-H. pylori eradication, submucosal invasive EGCs were detected more frequently in the H. pylori-eradication group (13/81 patients, 16%) than in the non-H. pylori-eradication group (4/81 patients, 4.9%; P = 0.021) [19]. The submucosal invasive gastric cancer tended to be more frequent in the H. pylori-EG (18%) than in the non-H. pylori-EG (8%; P = 0.051) [4].…”