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H. pylori eradication failed to reduce risk for gastric cancer after resection
Eradication of Helicobacter pylori, an established risk factor for the development of gastric cancer, did not significantly reduce the incidence of metachronous gastric carcinoma in patients who underwent endoscopic resection in a recent clinical trial.
Researchers in Seoul, South Korea, performed a prospective, open-label trial from 2005 to 2011 that included 901 patients with H. pylori who had been treated with endoscopic resection for early gastric cancer or gastric dysplasia. Two weeks after resection, patients were randomly assigned to an eradication therapy group (n=444) that received 20 mg omeprazole, 1 g amoxicillin and 500 mg clarithromycin twice daily for 1 week or a control group (n=457).
Follow-up endoscopic examination and evaluation of H. pylori status was performed at 3, 6, and 12 months, and then annually. Development of metachronous carcinoma was compared between patients with positive (n=453) and negative (n=427) H. pylori status on their final follow-up.
The median follow-up was 36.9 months, during which 2.3% of patients from the eradication group and 3.9% of controls developed metachronous carcinoma (P=.24). The incidence of metachronous carcinoma between the eradication group and controls did not differ significantly within 1 year (5 vs. 7; P=.78), or at 1 year (5 vs. 10; P=.45), 2 years (3 vs. 8; P=.22), 3 years (3 vs. 7; P=.34) and 4 years (1 vs. 6; P=.12). There were no significant differences in the development of metachronous carcinoma in patients with positive (3.5%) or negative (2.6%) final H. pylori status (P=.32).
“The eradication of H. pylori after endoscopic resection … [had] no significant impact on the incidence of metachronous gastric carcinoma,” the investigators wrote. They said further long-term studies are warranted, considering conflicting data were reported from similar studies.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Helicobacter pylori is a class 1 carcinogen for gastric cancer. Eradication of H. pylori infection is important to prevent later gastric pathology including cancer. Availability of endoscopy has resulted in early detection of H. pylori-associated gastric cancers and gastric dysplasia. With early detection endoscopic resection of these lesions are possible. It is not clear based on discrepant results in the literature if once patients develop precancerous changes of the gastric mucosa eradication of active H. pylori infection along with surgical treatment helps reduce the chance for future gastric cancer. The current study demonstrated that therapy to eradicate H. pylori in infected patients with gastric cancer or dysplasia undergoing endoscopic resection did not prevent later development of gastric malignancy. This study adds further evidence to the existing literature that emphasizes the need for early therapy of H. pylori infection before precancerous lesions, dysplasia and cancer develop.