FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Treatment for Helicobacter pylori infection cut the incidence of new gastric cancers in half among patients undergoing endoscopic resection of early gastric cancer, according to results of a recent randomized, placebo-controlled study.
Patients receiving H. pylori treatment also had greater improvement from baseline in grade of gastric corpus atrophy, compared with patients receiving placebo, according to the study. The results were published in the New England Journal of Medicine .
“We speculate that persistent inflammation of gastric mucosa with H. pylori infection promotes carcinogenesis and also increases tumor growth or invasiveness,” said Il Ju Choi, MD, PhD, of the Center for Gastric Cancer, National Cancer Center, Goyang, South Korea, and coauthors.
Patients with early gastric cancers not at risk for lymph node metastasis may benefit from endoscopic resection. However, these patients are at high risk of developing new gastric cancer, and usually experience glandular atrophy, or advanced loss of mucosal glandular tissue, the authors said.
One nonrandomized study suggested H. pylori eradication could prevent development of subsequent cancers after endoscopic resection, according to the authors, but subsequent open-label trials were inconsistent on whether the treatment reduced cancer incidence.
Accordingly, Dr. Choi and colleagues conducted a prospective, double-blind, placebo-controlled, randomized trial of 470 patients who underwent endoscopic resection for high-grade adenoma or early gastric cancer.
Of 396 patients included in an intention-to-treat analysis, 194 were randomized to receive antibiotics for H. pylori eradication, and 202 received placebo.
Over a median follow-up of 5.9 years, new gastric cancers developed in 14 patients (7.2%) who received treatment, and in 27 patients (13.4%) who received placebo (hazard ratio, 0.50; 95% confidence interval, 0.26-0.94; P = .03).
Histologic analysis, performed in 327 patients, showed that 48.4% of patients in the treatment group had improvement in atrophy grade at the gastric corpus lesser curvature, compared to just 15.0% of the placebo group (P less than .001), the investigators reported.
Mild adverse events were more frequent in the treatment arm (42.0% versus 10.2%; P less than .001), and there were no serious adverse events, they added.
Despite the approximate 50% reduction in incidence of new gastric cancers and histologic improvements, the researchers said that further study would be required to optimize treatment approaches for patients undergoing endoscopic resection for high-grade adenoma or early gastric cancer.
“H. pylori eradication reduces, but cannot completely abolish, the risk of metachronous gastric cancer,” wrote Dr. Choi and colleagues. “Thus, molecular markers, including aberrant methylation at specific genes, might help to identify high-risk patients even after successful eradication.”
The researchers reported that they had nothing to disclose related to the study.
SOURCE: Choi et al. N Engl J Med. 2018 Mar 22. doi: 10.1056/NEJMoa1708423.
