title: The association between Helicobacter pylori status and incidence of metachronous gastric cancer after endoscopic resection of early gastric cancer.
abstract: BACKGROUND
  The long-term effect of Helicobacter pylori eradication in preventing metachronous gastric cancer (GC) development after endoscopic resection (ER) of early gastric cancer (EGC) remains controversial. The aim of this study was to investigate the effect of H. pylori status on the incidence of metachronous GC after ER during long-term follow-up.
  
  
  METHODS
  We retrospectively reviewed the medical records of 374 patients who underwent ER for EGC. Helicobacter pylori status was assessed by histology, rapid urease test, and serology. According to the H. pylori status after ER, included patients were classified into H. pylori-negative group (n = 218), H. pylori-eradicated group (n = 49), and H. pylori-persistent group (n = 107). Metachronous GC incidence and risk factors according to H. pylori status were analyzed.
  
  
  RESULTS
  Median follow-up duration after ER was 4.3 years (range 1.0-11.3 years). During the follow-up period, metachronous GC had developed in 13 patients (6.0% [13/218]) in the H. pylori-negative group, 2 patients (4.1% [2/49]) in the H. pylori-eradicated group, and 16 patients (15.0% [16/107]) in the H. pylori-persistent group. Cumulative incidence of metachronous GC was significantly higher in patients with H. pylori-persistent group than in those with H. pylori-negative (p = .011, log-rank test) and H. pylori-eradicated group (p = .006, log-rank test). In a multivariate Cox proportional hazard model, age ≥65 years (hazard ratio [HR] 2.29, p = .038), family history of GC (HR 2.60, p = .014), and H. pylori-persistent status (HR 2.42, p = .019) were associated with metachronous GC development.
  
  
  CONCLUSIONS
  Persistent H. pylori infection after ER may increase risk of metachronous GC development.
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Kim
authors.forename: Il Ju
authors.initials: IJ
authors.lastname: Choi
authors.forename: Myeong-Cherl
authors.initials: MC
authors.lastname: Kook
authors.forename: Soo-Jeong
authors.initials: SJ
authors.lastname: Cho
authors.forename: Jong Yeul
authors.initials: JY
authors.lastname: Lee
authors.forename: Chan Gyoo
authors.initials: CG
authors.lastname: Kim
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.forename: Young-Woo
authors.initials: YW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D005260:Female; D016481:Helicobacter Infections / Q000150:complications*; D006651:Histocytochemistry; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012698:Serologic Tests; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D014510:Urease / Q000032:analysis
chemical_list: D014510:Urease
keywords: Endoscopic resection; Gastric cancer; Helicobacter pylori; Metachronous