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治疗幽门螺杆菌对于预防异时性胃癌的效果
Helicobacter pylori Therapy for the Prevention of Metachronous Gastric Cancer


Il Ju Choi ... 肿瘤 • 2018.03.22
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根除幽门螺杆菌对早期胃癌切除后异时性胃癌发生的预防作用

 

潘凯枫†‡,游伟程†‡*

†北京大学肿瘤医院;‡恶性肿瘤发病机制及转化研究教育部重点实验室

*通讯作者

 

胃癌的早期发现和治疗对于降低胃癌死亡率具有重要意义。日本、韩国由于广泛开展胃内镜筛查使早期胃癌诊断率达到50%~70%1,5年生存率提高到70%~80%2。早期胃癌治疗以内镜下切除和外科手术为主。然而,临床研究发现在早期胃癌切除后仍有部分患者在胃内其他部位发生新的胃癌,也称为异时性胃癌(metachronous gastric cancer),其原因是胃癌患者胃黏膜多伴有癌前病变发生,因此在切除胃癌后其他部位的癌前病变仍有演变成胃癌的可能。

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摘要


背景

局限于胃黏膜或黏膜下层的早期胃癌患者通常有黏膜腺组织的晚期丧失(腺体萎缩),并且随后(异时性)新胃癌的发生风险较高。幽门螺杆菌根除治疗对组织学改善和异时性胃癌预防的长期影响仍不清楚。

 

方法

在这项前瞻性、双盲、安慰剂对照、随机试验中,470例接受早期胃癌或高级别腺瘤内镜切除术的患者,分别接受了幽门螺杆菌抗生素根除治疗或安慰剂。两个主要结局是在1年随访时或随后的内镜检查中检测到异时性胃癌的发生率,以及3年随访时胃体小弯侧腺体萎缩分级相对于基线的改善。

 

结果

改良意向治疗分析人群共纳入396例患者(治疗组194例,安慰剂组202例)。在5.9年的中位随访期间,治疗组14例患者(7.2%)和安慰剂组27例患者(13.4%)发生异时性胃癌(治疗组风险比,0.50;95%置信区间,0.26~0.94;P=0.03)。在进行组织学分析的亚组的327例患者中,在治疗组48.4%的患者和安慰剂组15.0%的患者中观察到了胃体小弯侧萎缩分级相对于基线的改善(P<0.001)。没有严重不良事件;治疗组中轻度不良事件较常见(42.0% vs. 10.2%,P<0.001)。

 

结论

与接受安慰剂治疗的患者相比,接受幽门螺杆菌治疗的早期胃癌患者的异时性胃癌发生率较低,胃体萎缩分级相对于基线改善较多(由韩国国立癌症中心[National Cancer Center, South Korea]资助;在ClinicalTrials.gov注册号为NCT02407119)。





作者信息

Il Ju Choi, M.D., Ph.D., Myeong-Cherl Kook, M.D., Ph.D., Young-Il Kim, M.D., Soo-Jeong Cho, M.D., Ph.D., Jong Yeul Lee, M.D., Chan Gyoo Kim, M.D., Ph.D., Boram Park, M.S., and Byung-Ho Nam, Ph.D.
From the Center for Gastric Cancer (I.J.C., M.-C.K., Y.-I.K., S.-J.C., J.Y.L., C.G.K.) and the Biometrics Research Branch, Research Institute (B.P., B.-H.N.), National Cancer Center, Goyang, South Korea. Address reprint requests to Dr. Choi at the Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, South Korea, or at cij1224@ncc.re.kr.

 

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