Prescription of Helicobacter pylori (H pylori) eradication therapy within 1 year of gastric cancer treatment reduces the risk of later metachronous lesion development, according to study data published in Gastrointestinal Endoscopy.
Patients who received early eradication therapy had a significantly lower 5-year risk for gastric neoplasm development compared with patients who underwent H pylori eradication >1 year postresection. These trends persisted in patients who underwent endoscopic resection and those who underwent gastrectomy.
Investigators extracted data from the Korean National Health Insurance Service (NHIS) database, which comprises demographic and clinical information for all residents of South Korea. Researchers retrieved data from patients who underwent endoscopic resection or gastrectomy for gastric cancer between 2006 and 2013. To ensure that the cohort included only patients with early gastric cancer, individuals who received chemotherapy and/or radiation therapy during the perioperative period were excluded. Patients were assigned to 3 groups based on the timing of H pylori eradication: pre-resection; <1 year post-resection; and >1 year post-resection. The primary outcome was development of metachronous lesions in the post-eradication period. The researchers used the Kaplan-Meier method to determine lesion-free survival time in all eradication subgroups. They used Cox proportional hazard models to estimate the risk for metachronous lesions across patient subgroups. Models were adjusted for demographic and clinical covariates, including age, sex, body mass index (BMI), smoking habits, alcohol consumption, and comorbid conditions.
The study cohort comprised 19,767 patients, of whom 7452 and 12,315 underwent endoscopic resection and surgery, respectively. Median follow-up time was 46.8 months (interquartile range [IQR], 34.6-53.0 months). The 5-year cumulative incidence of metachronous lesions after endoscopic resection was 14.0% in patients who received pre-resection eradication; 12.3% in patients who received eradication <1 year post-resection; and 16.9% in patients who received eradication >1 year post-resection. Of patients who underwent surgery, the 5-year cumulative incidence rates of metachronous lesions were 1.2%, 1.3%, and 2.9% in the pre-resection, <1 year post-resection, and >1 year post-resection groups, respectively. Per Cox regression models, the risk for metachronous lesion development was not significantly different between the pre-resection and <1 year post-resection groups. However, the hazard ratio [HR] for metachronous lesion development was significantly lower with <1 year post-resection eradication compared with >1 year in both the endoscopic resection (0.79; 95% confidence interval [CI], 0.65-0.95) and surgical resection groups (HR, 0.39; 95% CI, 0.28-0.53). Late prescription of H pylori eradication therapy was nominally associated with metachronous cancer development, though results were not statistically significant.
These data support the prescription of H pylori eradication therapy within 1 year of resection or surgery in patients with early gastric cancer. Earlier eradication was associated with reduced risk for metachronous lesion development in both the endoscopic resection and gastrectomy groups. Of note, metachronous lesion risk was not significantly different between patients who received eradication therapy before resection and within 1 year of resection.
As a limitation, researchers noted that the study was conducted in South Korea, where the prevalence of both H pylori infection and gastric cancer is high. Replication in Western cohorts may be necessary to ensure data generalizability.
Kim HJ, Kim YJ, Seo SI, Shin WG, Park CH. Impact of the timing of Helicobacter pylori eradication on the risk of metachronous lesion development after the treatment of early gastric cancer: a population-based cohort study [published online May 27, 2020]. Gastrointest Endosc. doi: 10.1016/j.gie.2020.05.029