Preventive effects of etodolac, a selective cyclooxygenase-2 inhibitor, on cancer development in extensive metaplastic gastritis, a Helicobacter pylori-negative precancerous lesion.
The present study investigated the preventive effects of etodolac, a selective cyclo-oxygenase (COX)-2 inhibitor, on metachronous cancer development after endoscopic resection of early gastric cancer. Among 267 early gastric cancer patients who underwent endoscopic resection, 47 patients with extensive metaplastic gastritis were selected based on endoscopic findings and our previously described criteria of serum pepsinogen (PG) test-positive and Helicobacter pylori antibody-negative conditions. Nonrandomized etodolac treatment (300 mg/day) was administered to 26 patients (Group A), while the remaining 21 patients were untreated (Group B). No significant differences in age, sex distribution, lifestyle factors or extent of metaplastic gastritis at baseline were identified between groups. Patients were followed for metachronous cancer development with endoscopy every 6-12 months for up to 5 years. Mean (standard deviation) follow-up period was 4.2 (0.9) years. In Group B, 5 cancers developed (incidence rate = 6,266/100,000 person-years), significantly more than the 1 cancer in Group A (incidence rate = 898/100,000 person-years; p < 0.05). Long-term etodolac treatment did not influence the extent of metaplastic gastritis as revealed by endoscopic findings or by serum PG levels, but effectively reduced metachronous cancer development in patients with extensive metaplastic gastritis. These results strongly suggest that chemoprevention of cancer in the metaplastic stomach is possible by controlling COX-2 expression.
Yanaoka
Kimihiko
K
Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama City, Wakayama 641-0012, Japan.
Oka
Masashi
M
Yoshimura
Noriko
N
Deguchi
Hisanobu
H
Mukoubayashi
Chizu
C
Enomoto
Shotaro
S
Maekita
Takao
T
Inoue
Izumi
I
Ueda
Kazuki
K
Utsunomiya
Hirotoshi
H
Iguchi
Mikitaka
M
Tamai
Hideyuki
H
Fujishiro
Mitsuhiro
M
Nakamura
Yasushi
Y
Tsukamoto
Tetsuya
T
Inada
Kenichi
K
Takeshita
Tatsuya
T
Ichinose
Masao
M
D000368:Aged; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D017308:Etodolac / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005756:Gastritis / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000150:complications / Q000382:microbiology / Q000517:prevention & control; D013270:Stomach / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000150:complications / Q000517:prevention & control* / Q000601:surgery; D016896:Treatment Outcome
D052246:Cyclooxygenase 2 Inhibitors; D017308:Etodolac