Incidence of and risk factors for metachronous gastric cancer after endoscopic resection and successful Helicobacter pylori eradication: results of a large-scale, multicenter cohort study in Japan

Abstract

Background A previous multicenter prospective randomized study from Japan showed that Helicobacter pylori eradication reduced the development of metachronous gastric cancer (MGC) after endoscopic resection for early gastric cancer. MGC risk, however, is not eliminated; yet few studies have evaluated its long-term incidence and risk factors. In this study, we investigated the incidence of and risk factors for MGC in patients who underwent endoscopic resection for early gastric cancer with successful H. pylori eradication. Methods A total of 594 patients who underwent endoscopic resection for early gastric cancer and successful H. pylori eradication at three institutions (National Cancer Center Hospital, University of Tokyo Hospital, and Wakayama Medical University Hospital) were analyzed retrospectively. Annual endoscopic surveillance was performed after initial endoscopic resection. MGC was defined as a gastric cancer newly detected at least 1 year after successful H. pylori eradication. Results Ninety-four MGCs were detected in 79 patients during the 4.5-year median follow-up period. KaplanMeier analysis showed the cumulative incidence of MGC 5 years after successful H. pylori eradication was 15.0 %; the incidence of MGC calculated by use of the person-year method was 29.9 cases per 1000 person-years. Multivariate analysis using the Cox proportional hazards model revealed that male sex, severe gastric mucosal atrophy, and multiple gastric cancers before successful H. pylori eradication were independent risk factors for MGC. Eleven percent of MGCs (10 of 94) were detected more than 5 years after successful H. pylori eradication. Conclusion Surveillance endoscopy for MGC in patients who have undergone endoscopic resection for early gastric cancer should be performed even after successful H. pylori eradication.

Preventing Metachronous Gastric Cancer after the Endoscopic Resection of Gastric Epithelial Neoplasia: Roles of <i>Helicobacter pylori</i> Eradication and Aspirin

“…In their large-scale, multicenter cohort study, the annual incidence of MGC after H. pylori eradication was relatively high (3.0%, cumulative incidence 15.0% at 5 years after eradication), and was similar to the incidence found in another study from Japan. 14 In addition, the incidence in the multicenter cohort study by Mori et al (29.9 cases per 1,000 person-years) 72 was double the incidence found in other studies (14.1 cases per 1000 person-years 11 and 14.7 cases per 1,000 person-years 73 ). This incidence of MGC was also significantly higher than that found by Choi et al (estimated incidence: approximately 5.7 to 7.5 cases per 1,000 person-years).…”

“…As mentioned above, the GC risk after H. pylori eradication is different between primary GC that develops in healthy individuals or peptic ulcer patients and MGC. According to a survey conducted in Japan by Mori et al, 72 the annual incidences of primary GC and MGC ranged from 0.1% to 0.5% and from 0.8% to 4.1%, respectively. In their large-scale, multicenter cohort study, the annual incidence of MGC after H. pylori eradication was relatively high (3.0%, cumulative incidence 15.0% at 5 years after eradication), and was similar to the incidence found in another study from Japan.…”

Risk of metachronous gastric neoplasm occurrence during intermediate-term follow-up period after endoscopic submucosal dissection for gastric dysplasia

“…However, in this study, the incidence of metachronous gastric cancer was approximately 1% per year (9.1 cases/1,000 person-years) in patients with successful H. pylori eradication 20 . A cohort study also showed approximately 3% annual incidence (29.9 cases/1,000 person-years) of metachronous gastric cancer after ER for EGC in H. pylori eradicated patients 23 . These data suggest that long-term endoscopic surveillance after ER might be needed in patients with EGC even after successful H. pylori eradication.…”

Does remnant gastric cancer really differ from primary gastric cancer? A systematic review of the literature by the Task Force of Japanese Gastric Cancer Association

“…Remnant cancer that develops through etiologies that are identical to that of the primary cancer may emerge relatively early after the primary surgery, whereas cancer caused by reflux of the duodenal contents may emerge late. Based on the frequency of location of primary gastric cancer, particularly depending on Helicobacter pylori-induced carcinogenesis [37], the incidence of metachronous multiple cancers may be higher after proximal gastrectomy. Perhaps proximal gastrectomy may induce additional risk for RGC when compared with distal gastrectomy.…”