title: Helicobacter pylori infection-negative gastric cancer in Japanese hospital patients: incidence and pathological characteristics.
abstract: We used Helicobacter pylori sero-positivity and mucosal atrophy as detected by the serum pepsinogen method to identify H. pylori infection-negative gastric cancer patients with or without atrophy. One hundred and six of 748 (14.2%) primary gastric cancer patients were infection-negative by a serum antibody detection system. Further, 121 (16.2%) of the 748 were negative for gastric mucosal atrophy by the pepsinogen method, of whom 15/748 (2.0%) were H. pylori-negative by pepsinogen I level (>70 ng/mL) and pepsinogen I/II ratio (>3.0). Twenty-seven of 782 (3.6%) gastric cancer patients were H. pylori-negative by antibodies and severe atrophy as determined by pepsinogen I level (<30 ng/mL) and pepsinogen I/II ratio (<2.0). H. pylori-negative gastric cancer patients with severe atrophy likely had a previous infection. These results indicate that the actual number of H. pylori-negative patients is 2.0% at minimum and 10.6% (14.2% minus 3.6%) at maximum in the general Japanese population. Five of 15 (33%) cases displaying neither anti-H. pylori antibodies nor atrophy were intestinal-type and 10 (67%) were diffuse-type adenocarcinomas. Thirteen surgical patients with primary gastric cancer displaying neither antibodies nor mucosal atrophy were further analyzed for pathological and phenotypic characteristics. The mucin phenotype was divided into four gastric, five gastric and intestinal, two intestinal and two null types, independent of histological classification. Intestinal phenotype elements were detected by Cdx2 immunohistochemical methods in nine of 13 (70%) cases examined. We conclude that a small fraction of gastric cancer patients displayed multifactorial carcinogenesis without H. pylori infection, indicating that gastric cancer risk still exists in the absence of H. pylori infection, at an incidence of 2.0% at minimum and 10.6% at maximum in the general Japanese population.
authors.affiliation: Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan. katoshun@nms.ac.jp
authors.forename: Shunji
authors.initials: S
authors.lastname: Kato
authors.forename: Norio
authors.initials: N
authors.lastname: Matsukura
authors.forename: Katsuya
authors.initials: K
authors.lastname: Tsukada
authors.forename: Noriko
authors.initials: N
authors.lastname: Matsuda
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Mizoshita
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Masae
authors.initials: M
authors.lastname: Tatematsu
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sugisaki
authors.forename: Zenya
authors.initials: Z
authors.lastname: Naito
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology / Q000821:virology*; D000368:Aged; D000907:Antibodies, Bacterial / Q000032:analysis; D044466:Asian People; D001284:Atrophy; D000071616:CDX2 Transcription Factor; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D016481:Helicobacter Infections / Q000453:epidemiology*; D016480:Helicobacter pylori / Q000276:immunology; D018398:Homeodomain Proteins / Q000378:metabolism; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000378:metabolism / Q000382:microbiology* / Q000473:pathology; D015534:Trans-Activators / Q000378:metabolism
chemical_list: D000907:Antibodies, Bacterial; D000071616:CDX2 Transcription Factor; D018398:Homeodomain Proteins; D015534:Trans-Activators; D020116:Pepsinogen A