幽门螺杆菌的清除可减少胃癌复发率并改善胃萎缩情况
Title：
Helicobacter pylori Therapy for the Prevention of Metachronous Gastric Cancer
Abstract：
Background Patients with early gastric cancers that are limited to gastric mucosa or submucosa usually have an advanced loss of mucosal glandular tissue (glandular atrophy) and are at high risk for subsequent (metachronous) development of new gastric cancer. The long-term effects of treatment to eradicate Helicobacter pylori on histologic improvement and the prevention of metachronous gastric cancer remain unclear. Methods In this prospective, double-blind, placebo-controlled, randomized trial, we assigned 470 patients who had undergone endoscopic resection of early gastric cancer or high-grade adenoma to receive either H. pylori eradication therapy with antibiotics or placebo. Two primary outcomes were the incidence of metachronous gastric cancer detected on endoscopy performed at the 1-year follow-up or later and improvement from baseline in the grade of glandular atrophy in the gastric corpus lesser curvature at the 3-year follow-up. Results A total of 396 patients were included in the modified intention-to-treat analysis population (194 in the treatment group and 202 in placebo group). During a median follow-up of 5.9 years, metachronous gastric cancer developed in 14 patients (7.2%) in the treatment group and in 27 patients (13.4%) in the placebo group (hazard ratio in the treatment group, 0.50; 95% confidence interval, 0.26 to 0.94; P=0.03). Among the 327 patients in the subgroup that underwent histologic analysis, improvement from baseline in the atrophy grade at the gastric corpus lesser curvature was observed in 48.4% of the patients in the treatment group and in 15.0% of those in the placebo group (P<0.001). There were no serious adverse events; mild adverse events were more common in the treatment group (42.0% vs. 10.2%, P<0.001). Conclusions Patients with early gastric cancer who received H. pylori treatment had lower rates of metachronous gastric cancer and more improvement from baseline in the grade of gastric corpus atrophy than patients who received placebo. (Funded by the National Cancer Center, South Korea; ClinicalTrials.gov number, NCT02407119 .).
All Authors：
Il Ju Choi,Myeong-Cherl Kook,Young-Il Kim,Soo-Jeong Cho,Jong Yeul Lee,Chan Gyoo Kim,Boram Park,Byung-Ho Nam
First Authors：
Il Ju Choi
Correspondence：
Il Ju Choi
摘要：
对470名早期胃癌或腺瘤切除术后患者，给予抗生素或安慰剂治疗幽门螺杆菌； 分析纳入治疗组194例，安慰剂组202例，异时性胃癌分别发病14和27例，治疗使发病率降低约50%； 在327名患者中另发现，治疗组48.4%和安慰剂组15.0%的患者胃体小弯曲率指标（胃萎缩程度）有改善，两组差异显著；未发生严重不良事件，中度不良事件在治疗组更普遍；最终发现接受抗菌治疗可降低胃癌复发率和改善胃萎缩情况。