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Regular NSAID use may protect H. pylori-infected patients against gastric cancer
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A large retrospective cohort study conducted in Taiwan found that regular use of nonsteroidal anti-inflammatory drugs could reduce the risk of gastric cancer among those with gastric ulcers and especially in gastric ulcer patients infected with Helicobacter pylori.
“Elucidation of inflammation-based carcinogenesis offers new opportunities for gastric cancer chemoprevention,” researchers wrote. “Aspirin and NSAIDs have been suggested to prevent gastric cancer by inhibiting production of cyclooxygenase-1 and Cox-2 through both prostaglandin-dependent and -independent pathways.”
In the study, 52,161 peptic ulcer patients were divided into groups of non-NSAID users (n=27,016) and regular NSAID users (n=25,145). Those who never used NSAIDs had a higher risk of gastric cancer compared to the general population (standardized incidence ratio [SIR]=2.11; 95% CI, 2.07-2.15), and regular NSAID use was associated with lower risk (SIR=0.79; 95% CI, 0.77-0.81).
In a multivariate analysis, regular use of NSAIDs was a protective factor for gastric cancer development (HR=0.79 for each incremental year, P<.001). The protective effect was even stronger among those patients infected with H. pylori (HR=0.52 for each incremental year; P<.001). In patients with H. pylori-infected gastric ulcers, the number needed to treat to prevent a single gastric cancer was 50, reduced from 589 for all peptic ulcer patients.
“NSAIDs inhibit the replication and proliferation of H. pylori and potentially increase H. pylori clearance,” the researchers wrote. “But how H. pylori infection impacts the chemopreventive effect of NSAID use remains unclear.” They concluded that NSAIDs may be a feasible method for preventing gastric cancer in these patients.
Wu CY. J Clin Oncol. 2010;10.1200/JCO.2009.26.0695.