胃癌家族史与幽门螺杆菌感染治疗

摘要

背景

幽门螺杆菌感染和胃癌家族史是胃癌的主要危险因素。目前尚未明确根除幽门螺杆菌可否降低有胃癌家族史（一级亲属患胃癌）的人患胃癌的风险。

方法

在这项单中心、双盲、安慰剂对照试验中，我们筛选了胃癌患者的3,100名一级亲属。我们将有幽门螺杆菌感染的1,838名参与者随机分组，分别接受根除治疗（兰索拉唑[30 mg]、阿莫西林[1,000 mg]和克拉霉素[500 mg]，三种药物均为每日用药2次，用药7日）或安慰剂治疗。主要结局是发生胃癌。预设的次要结局是随访期间根据幽门螺杆菌根除状况判定的发生胃癌情况。

结果

共计1,676名参与者被纳入改良意向治疗人群，用于分析主要结局（治疗组832名，安慰剂组844名）。在中位9.2年随访期间，治疗组10名参与者（1.2%）和安慰剂组23名参与者（2.7%）发生了胃癌（风险比，0.45；95%置信区间[CI]，0.21～0.94；时序检验，P=0.03）。在发生胃癌的治疗组10名参与者中，5名（50.0%）有持续幽门螺杆菌感染。有0.8%（5/608）根除幽门螺杆菌感染的参与者和2.9%（28/979）持续感染的参与者发生胃癌（风险比，0.27；95% CI，0.10～0.70）。不良事件为轻度，且治疗组发生率高于安慰剂组（53.0% vs. 19.1%；P＜0.001）。

结论

在有胃癌家族史（一级亲属患胃癌）的幽门螺杆菌感染者中，根除幽门螺杆菌可降低患胃癌的风险（由韩国国家癌症中心[National Cancer Center]资助，在ClinicalTrials.gov注册号为NCT01678027）。

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作者信息

Il Ju Choi, M.D., Ph.D., Chan Gyoo Kim, M.D., Ph.D., Jong Yeul Lee, M.D., Young-Il Kim, M.D., Myeong-Cherl Kook, M.D., Ph.D., Boram Park, Ph.D., and Jungnam Joo, Ph.D.
From the Center for Gastric Cancer (I.J.C., C.G.K., J.Y.L., Y.-I.K., M.-C.K.), the Division of Cancer Epidemiology and Management, Research Institute (I.J.C., Y.-I.K., B.P., J.J.), and the Biostatistics Collaboration Team, Research Core Center, Research Institute (B.P.) — all at the 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, Gyeonggi, 10408, South Korea, or at cij1224@ncc.re.kr.

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