Risk Assessment of Metachronous Gastric Neoplasm after Endoscopic Resection for Early Gastric Cancer According to Age at Helicobacter pylori Eradication
Seunghan Lee,
Soo-Jeong Cho,
Hyunsoo Chung,
Bokyung Kim,
Mi Jin Oh,
Yun Suk Na,
Jun Hee Lee,
Jiyoon Kim,
Sang Gyun Kim
Affiliations
Seunghan Lee
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
Soo-Jeong Cho
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
Hyunsoo Chung
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
Bokyung Kim
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
Mi Jin Oh
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
Yun Suk Na
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
Jun Hee Lee
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
Jiyoon Kim
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
Sang Gyun Kim
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
Background/Aims: Helicobacter pylori eradication can reduce the incidence of metachronous gastric neoplasm (MGN) after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). This study evaluated the risk of developing MGN after ESD for EGC based on age at H. pylori eradication.Methods: Data of patients who underwent curative ESD for EGC with H. pylori infection between 2005 and 2018 were retrospectively analyzed. The patients were allocated to four groups according to age at H. pylori eradication: group 1 (<50 years), group 2 (50-59 years), group 3 (60-69 years), and group 4 (≥70 years).Results: All patients were followed up for at least 5 years after ESD. The 5-year cumulative incidence of MGN was 2.1%, 7.0%, 8.7%, and 16.7% in groups 1, 2, 3, and 4, respectively (p<0.001), and groups 3 and 4 showed a significant increase in the risk of MGN (hazard ratio [HR], 4.66; 95% confidence interval [CI], 1.09 to 19.92 and HR, 10.75; 95% CI, 2.45 to 47.12). After adjustments for moderate to severe intestinal metaplasia based on the updated Sydney system, groups 3 and 4 remained significantly associated with MGN (HR, 4.40; 95% CI, 1.03 to 18.84 and HR, 10.14; 95% CI, 2.31 to 44.57).Conclusions: The incidence of MGN after ESD for EGC increased with age at H. pylori eradication. Age at H. pylori eradication ≥60 years was an independent risk factor for MGN, even after adjusting for the presence of advanced intestinal metaplasia.
