title: Factors Associated With Metachronous Gastric Cancer Development After Endoscopic Submucosal Dissection for Early Gastric Cancer.
abstract: OBJECTIVE
  To clarify the factors associated with metachronous gastric cancer development after endoscopic submucosal dissection (ESD) for early gastric cancer.
  
  
  BACKGROUND
  Patients who undergo ESD for early gastric cancer have an appreciable risk of developing metachronous gastric cancer. However, there have been few reports on the association between life style and the development of such cancer.
  
  
  METHODS
  Patients with early gastric cancer who underwent ESD at our institution between 2003 and 2012 were enrolled. Metachronous gastric cancer was defined as secondary gastric cancer detected >1 year after initial ESD. Factors, including age, gender, body mass index, eradication of Helicobacter pylori, cigarette smoking, drinking, and continuous use of a proton pump inhibitor, associated with metachronous gastric cancer development were evaluated by Cox proportional hazard regression analysis.
  
  
  RESULTS
  A total of 539 patients with a mean 53.6-month follow-up period were analyzed. The 5-year cumulative incidence of secondary gastric cancer was 13.0%. Multivariate analysis exhibited that age of 60 years and above [hazard ratio (95% confidence interval)=4.05 (1.23-13.4)] and cigarette smoking [2.12 (1.19-3.78)] were independent risk factors for metachronous gastric cancer development. Furthermore, ≥20 pack-years of smoking [1.51 (1.03-2.24)] was a significant risk factor with a dose-response relationship (P for trend=0.042). There was no significant association between Helicobacter pylori eradication and metachronous gastric cancer development.
  
  
  CONCLUSIONS
  This is the first study to demonstrate the detailed association between cigarette smoking and metachronous gastric cancer development.
authors: *Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai †Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan.
authors: Reiko
authors: R
authors: Ami
authors: Waku
authors: W
authors: Hatta
authors: Katsunori
authors: K
authors: Iijima
authors: Tomoyuki
authors: T
authors: Koike
authors: Hideki
authors: H
authors: Ohkata
authors: Yutaka
authors: Y
authors: Kondo
authors: Nobuyuki
authors: N
authors: Ara
authors: Kiyotaka
authors: K
authors: Asanuma
authors: Naoki
authors: N
authors: Asano
authors: Akira
authors: A
authors: Imatani
authors: Tooru
authors: T
authors: Shimosegawa
mesh_terms: D000368:Aged; D000073865:Cigarette Smoking; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery; D016481:Helicobacter Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000473:pathology; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery
chemical_list: D054328:Proton Pump Inhibitors