The Effect of Helicobacter pylori Eradication on the Metachronous Neoplasm after Endoscopic Resection for Gastric Dysplasia

Ji Hyun Song; Sun Young Yang; Joo Hyun Lim; Ji Min Choi; Sang Gyun Kim

doi:10.4166/kjg.2017.70.1.27

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Song, Yang, Lim, Choi, and Kim: The Effect of Helicobacter pylori Eradication on the Metachronous Neoplasm after Endoscopic Resection for Gastric Dysplasia

Original Article

Korean J Gastroenterol 2017;70(1):27-32.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.70.1.27

The Effect of Helicobacter pylori Eradication on the Metachronous Neoplasm after Endoscopic Resection for Gastric Dysplasia

Ji Hyun Song, Sun Young Yang, Joo Hyun Lim, Ji Min Choi, Sang Gyun Kim¹

Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea

¹Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

Correspondence to: Sun Young Yang, Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 152 Teheran-ro, Gangnam-gu, Seoul 06236, Korea. Tel: +82-2-2112-5632, Fax: +82-2-2112-5794, E-mail: syyang@snuh.org

Received 17 April 2017 Revised 16 May 2017 Accepted 26 May 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Helicobacter pylori (Hp) infection is an important risk factor for gastric carcinogenesis. Although several studies have investigated the effect of Hp eradication on the development of metachronous neoplasm after endoscopic resection of the gastric dysplasia, the evidence is still insufficient to make a clear conclusion. The aims of this study was to evaluate the risk factors for the development of metachronous neoplasm after endoscopic resection of gastric dysplasia and to investigate the effect of Hp eradication.

Methods

Between 2005 and 2011, a total of 887 patients underwent endoscopic resection for gastric dysplasia. Among them, 521 patients who had undergone tests for Hp infection and been followed-up for at least one year were included in the final analyses. Of the 292 Hp-positive patients, 116 patients were successfully eradicated, while 176 failed or did not undergo eradication.

Results

During a mean follow-up of 59.1 months (range 12–125 months), metachronous neoplasm had developed in 63 patients (12.1%, dysplasia in 38, carcinoma in 25). In multivariate analyses, age ≥65 (hazard ratio [HR]=2.247, 95% confidence interval [CI] 1.297–3.895), tumor size (HR=1.283, 95% CI 1.038–1.585), synchronous lesion (HR=2.341, 95% CI 1.244–4.405), family history of gastric cancer (HR=3.240, 95% CI 1.776–5.912), and smoking (HR=1.016, 95% CI 1.003–1.029) were risk factors for metachronous neoplasm after endoscopic resection of gastric dysplasia. However, Hp eradication was not associated with metachronous neoplasm (HR=0.641, 95% CI 0.297–1.384).

Conclusions

Hp eradication was not shown to be associated with the development of metachronous cancer after endoscopic resection of gastric dysplasia.

Keywords: Helicobacter pylori, Metachronous neoplasm, Precancerous condition, Endoscopic mucosal resection

References

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Fig. 1.

Cumulative incidence rate of metachronous tumor (Kaplan-Meier survival curve). There was no significant difference of cumulative incidence rate of metachronous tumor in accordance with the status of Helicobacter pylori (Hp) infection.

Table 1.

Baseline Characteristics of the Study Population

	Total (n=521)
Age, years	60.96±8.00
<65	326 (62.6)
≥65	195 (37.4)
Sex
Female	197 (37.8)
Male	324 (62.2)
Hp status
No infection	229 (44.0)
Eradicated	116 (22.3)
Not eradicated	176 (33.8)
Location
Upper third	12 (2.3)
Middle third	215 (41.3)
Lower third	294 (56.4)
Size (cm)	1.43±1.00
Synchronous lesion
No	464 (89.1)
Yes	57 (10.9)
Histological grade
Low grade dysplasia	386 (74.1)
High grade dysplasia	135 (25.9)
Endoscopic resection
EMR	10 (1.9)
ESD	511 (98.1)
Intestinal metaplasia, initial
No	53 (10.3)
Yes	463 (89.7)
Family history of GC
No	438 (85.4)
Yes	75 (14.6)
Smoking (pack-year)	9.29±16.73
0	346 (68.9)
<20	42 (8.4)
≥20	114 (22.7)
Alcohol (g/d)	10.16±22.68
Follow up period (months)	59.11±28.98
Metachronous neoplasm	63 (12.1)
Dysplasia	38 (60.3)
Carcinoma	25 (39.7)

Data represent means±standard deviations for continuous variables and numbers (%) for categorical variables.

Hp, Helicobacter pylori; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; GC, gastric cancer.

Table 2.

Associated Factors for Metachronous Neoplasm of Gastric Dysplasia

	Metachronous neoplasm (−)(n=458)	Metachronous neoplasm (+)(n=63)	p-value	HR ^a	95% CI ^a
Age			0.004 ^b
<65	297 (64.8)	29 (46.0)		Reference
≥65	161 (35.2)	34 (54.0)		2.425	1.474–3.987
Sex			0.059 ^b
Female	180 (39.3)	17 (27.0)		Reference
Male	278 (60.7)	46 (73.0)		1.583	0.907–2.762
Hp status			0.104 ^b
No infection	194 (42.4)	35 (55.6)		Reference
Eradicated	107 (23.4)	9 (14.3)		0.498	0.239–1.036
Not eradicated	157 (34.3)	19 (30.2)		0.709	0.406–1.240
Location			0.230 ^b
Upper third	9 (2.0)	3 (4.8)		Reference
Middle third	186 (40.6)	29 (46.0)		0.527	0.160–1.734
Lower third	263 (57.4)	31 (49.2)		0.388	0.118–1.270
Size (cm)	1.37±0.93	1.88±1.32	<0.001 ^c	1.430	1.192–1.714
Synchronous lesion(s)			<0.001 ^b
No	416 (90.8)	48 (76.2)		Reference
Yes	42 (9.2)	15 (23.8)		2.791	1.562–4.988
Histological grade			0.102 ^b
Low grade dysplasia	334 (72.9)	52 (82.5)		Reference
High grade dysplasia	124 (27.1)	11 (17.5)		0.539	0.160–1.734
Intestinal metaplasia			0.017 ^b
No	52 (11.5)	1 (1.6)		Reference
Yes	402 (88.5)	61 (98.4)		7.956	1.103–57.401
Family history of GC			0.001 ^b
No	393 (87.3)	45 (71.4)		Reference
Yes	57 (12.7)	18 (28.6)		2.755	1.594–4.761
Smoking (pack-year)	8.42±15.69	15.89±22.25	0.001 ^c	1.017	1.006–1.029
Alcohol (g/d)	9.35±21.38	16.08±30.11	0.031 ^c	1.006	0.998–1.014
Follow up period (months)	60.66±29.41	47.84±22.80	0.001 ^c	−	−

Data represent means±standard deviations for continuous variables and numbers (%) for categorical variables.

HR, hazard ratio; CI, confidence interval; Hp, Helicobacter pylori; GC, gastric cancer.

^a Univariate analyses of risk factors for metachronous neoplasm by Cox regression analysis

^b Statistical analysis was performed by Pearson's chi-square

^c Statistical analysis was performed by Student's t-test.

Table 3.

Risk Factors for Metachronous Cancer after Endoscopic Resection of Gastric Dysplasia

	HR ^a	95% CI ^a
Age ≥65	2.247	1.297–3.895
Male sex	1.047	0.557–1.970
Hp status
No infection	Reference
Eradicated	0.641	0.297–1.384
Not eradicated	1.103	0.601–2.026
Size (cm)	1.283	1.038–1.585
Synchronous lesion(s)	2.341	1.244–4.405
Intestinal metaplasia	4.884	0.669–35.663
Family history of GC	3.240	1.776–5.912
Smoking (pack-year)	1.016	1.003–1.029

Hp, Helicobacter pylori; GC, gastric cancer.

^a Multivariate analyses adjusted for age, sex, Hp status, size, synchronous lesion(s), intestinal metaplasia, family history of gastric cancer, and smoking.

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