Helicobacter pylori Seropositivity and Subsite-Specific Gastric Cancer Risks in Linxian, China

Limburg, Paul J.; Qiao, You Lin; Mark, Steven D.; Wang, Guoqing; Pérez-Pérez, Guillermo I.; Blaser, Martin J.; Wu, Yan; Zou, Xiao; Dong, Zhi Wei; Taylor, Philip Russel; Dawsey, Sanford M.

doi:10.1093/jnci/93.3.226

Cited by 97 publications

(99 citation statements)

References 49 publications

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“…The prevalence of H pylori infection in patients with cardia and non-cardia adenocarcinoma was about 70%, significantly higher than control subjects (about 56%), which was similar to the previous study done in China [4] . Fewer cardia cancer patients (n = 29) were noted in our study, but the prevalence of H pylori and CagA seropositivity was similar to that in non-cardia cancer patients.…”

Section: Discussionsupporting

confidence: 89%

“…However, there is debate in regard to the association between H pylori infection and gastric cardia adenocarcinoma. Most studies in Asian countries [3][4][5] have indicated an increased risk of cardia cancer in H pylori-infected subjects, while those in Western countries have reported a protective role of H pylori [6] or a negative association [7][8][9] between these two.…”

Section: Introductionmentioning

confidence: 99%

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Association between Helicobacter pylori seropositivity anddigestive tract cancers

Wu²,

Yu³

et al. 2009

WJG

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AIM:To explore the role of Helicobacter pylori (H pylori ) infection on the risk of digestive tract cancers. METHODS:In total, 199 oral squamous-cell carcinoma (SCC), 317 esophageal SCC, 196 gastric cardia and non-cardia adenocarcinoma and 240 colon adenocarcinoma patients were recruited for serum tests of H pylori infection. Two hospital-and one community-based control groups were used for the comparisons. H pylori seropositivity was determined by an enzyme linked immunosorbent assay method against H pylori IgG. RESULTS: Presence of H pylori infection was signifi-cantly inversely associated with esophageal SCC [adjusted odds ratio (AOR): 0.315-0.472, all P -value < 0.05] but positively associated with gastric adenocarcinoma (both cardia and non-cardia) (AOR: 1.636-3.060, all P -value < 0.05) in comparison to the three control groups. Similar results were not found in cancers of the oral cavity and colon. CONCLUSION: Our findings support the finding thatH pylori seropositivity is inversely associated with esophageal SCC risk, but increases the risk of gastric cardia adenocarcinoma.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Association between Helicobacter pylori seropositivity anddigestive tract cancers

Wu²,

Yu³

et al. 2009

WJG

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“…The lack of Helicobacter pylori infection data for the entire cohort in our present study may represent a limitation because a previous nested case-control study of this same population found an increased risk of both GCC and GNCC among individuals with Helicobacter pylori infection. 36 Using data for 192 controls from the previous study, however, no significant correlations between Helicobacter pylori infection and age, gender, height, weight, BMI, birthplace, education and water supply were found (data not shown). Thus, confounding by Helicobacter pylori infection is unlikely to account for the results in our study.…”

Section: Discussionmentioning

confidence: 82%

Prospective study of risk factors for esophageal and gastric cancers in the Linxian general population trial cohort in China

Tran

Sun

Abnet

et al. 2004

Intl Journal of Cancer

603

576

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Esophageal cancer incidence and mortality rates in Linxian, China are among the highest in the world. We examined risk factors for esophageal squamous cell carcinoma (ESCC), gastric cardia cancer (GCC), and gastric noncardia cancer (GNCC) in a populationbased, prospective study of 29,584 adults who participated in the Linxian General Population Trial. All study participants completed a baseline questionnaire that included questions on demographic characteristics, personal and family history of disease, and lifestyle factors. After 15 years of follow-up, a total of 3,410 incident upper gastrointestinal cancers were identified, including 1,958 ESCC, 1,089 GCC and 363 GNCC. Cox proportional hazard models were used to estimate risks. Increased age and a positive family history of esophageal cancer (including ESCC or GCC) were significantly associated with risk at all 3 cancer sites. Additional risk factors for ESCC included being born in Linxian, increased height, cigarette smoking and pipe smoking; for GCC, male gender, consumption of moldy breads and pipe smoking; and for GNCC, male gender and cigarette smoking. Protective factors for ESCC included formal education, water piped into the home, increased consumption of meat, eggs and fresh fruits and increased BMI; for GCC, formal education, water piped into the home, increased consumption of eggs and fresh fruits and alcohol consumption; and for GNCC, increased weight and BMI. General socioeconomic status (SES) is a common denominator in many of these factors and improving SES is a promising approach for reducing the tremendous burden of upper gastrointestinal cancers in Linxian.Key words: gastric cardia cancer; gastric noncardia cancer; cohort studies; diet; smoking Esophageal cancer is the sixth most common cause of cancerrelated death worldwide. 1 Some of the world's highest incidence and mortality rates of esophageal cancer occur in China. 2,3 Considerable geographic variation exists in these rates across the country, with the most prominent cluster seen in North Central China, particularly in Lin county (Linxian). 3,4 Esophageal cancer mortality rates in Linxian exceed the Chinese average rates by 10-fold and the rates among Caucasian Americans by 100-fold. 5 In Linxian, esophageal squamous cell carcinoma and gastric cardia cancer are both frequent and have traditionally been considered a single disease, esophageal cancer, because of their similar symptoms. Reasons for the unusually high rates of esophageal and gastric cardia cancers in the Linxian population are unclear, but recent reports suggest that rates have begun to decline. 6 Although tobacco smoking and alcohol drinking account for over 90% of esophageal squamous cell carcinoma in the West, 7,8 previous studies have shown that they are not important contributing factors to the development of cancer in Linxian. 9,10 The geographic variation in occurrence in China strongly suggests that environmental or lifestyle factors are major contributors to the etiology of esophageal/gastric cardia cancer. Diet ha...

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“…Serum was evaluated for IgG antibodies to whole-cell (WC) and CagA H. pylori antigens by enzyme-linked immunosorbent assay, as described previously (Limburg et al, 2001). Similar to previous studies (Limburg et al, 2001), seropositivity cutpoints were defined as optical density ratios X1.0 for WC antibodies and X0.35 for CagA antibodies.…”

Section: Serologic Assaysmentioning

confidence: 99%

“…Similar to previous studies (Limburg et al, 2001), seropositivity cutpoints were defined as optical density ratios X1.0 for WC antibodies and X0.35 for CagA antibodies. Individuals who were negative for both antibodies (WCÀ, CagAÀ) were classified as H. pylori seronegative, whereas individuals who were seropositive for either WC or CagA antibodies were classified as H. pylori seropositive.…”

Section: Serologic Assaysmentioning

confidence: 99%

Helicobacter pylori and oesophageal and gastric cancers in a prospective study in China

et al. 2006

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In a cohort of 29 584 residents of Linxian, China, followed from 1985 to 2001, we conducted a case -cohort study of the magnitude of the association of Helicobacter pylori seropositivity with cancer risk in a random sample of 300 oesophageal squamous cell carcinomas, 600 gastric cardia adenocarcinomas, all 363 diagnosed gastric non-cardia adenocarcinomas, and a random sample of the entire cohort (N ¼ 1050). Baseline serum was evaluated for IgG antibodies to whole-cell and CagA H. pylori antigens by enzymelinked immunosorbent assay. Risks of both gastric cardia and non-cardia cancers were increased in individuals exposed to H. pylori (Hazard ratios (HRs) and 95% confidence intervals ¼ 1.64; 1.26 -2.14, and 1.60; 1.15 -2.21, respectively), whereas risk of oesophageal squamous cell cancer was not affected (1.17; 0.88 -1.57). For both cardia and non-cardia cancers, HRs were higher in younger individuals. With longer time between serum collection to cancer diagnosis, associations became stronger for cardia cancers but weaker for non-cardia cancers. CagA positivity did not modify these associations. The associations between H. pylori exposure and gastric cardia and non-cardia adenocarcinoma development were equally strong, in contrast to Western countries, perhaps due to the absence of Barrett's oesophagus and oesophageal adenocarcinomas in Linxian, making all cardia tumours of gastric origin, rather than a mixture of gastric and oesophageal malignancies.

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Helicobacter pylori Seropositivity and Subsite-Specific Gastric Cancer Risks in Linxian, China

Abstract: H. pylori seropositivity was associated with increased risks for both gastric cardia cancer and noncardia gastric cancer in this well-characterized cohort. Thus, H. pylori carriage may increase the risk of cancer throughout the stomach.

Cited by 97 publications

References 49 publications

Association between Helicobacter pylori seropositivity anddigestive tract cancers

Association between Helicobacter pylori seropositivity anddigestive tract cancers

Prospective study of risk factors for esophageal and gastric cancers in the Linxian general population trial cohort in China

Helicobacter pylori and oesophageal and gastric cancers in a prospective study in China

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