Helicobacter pylori Eradication for Prevention of Metachronous Recurrence after Endoscopic Resection of Early Gastric Cancer

Controversies persist regarding the effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer (EGC). The aim of this study was to assess the efficacy of Helicobacter pylori eradication after endoscopic resection of EGC for the prevention of metachronous gastric cancer. A systematic literature review and meta-analysis were conducted using the core databases PubMed, EMBASE, and the Cochrane Library. The rates of development of metachronous gastric cancer between the Helicobacter pylori eradication group vs. the non-eradication group were extracted and analyzed using risk ratios (RRs). A random effect model was applied. The methodological quality of the enrolled studies was assessed by the Risk of Bias table and by the Newcastle-Ottawa Scale. Publication bias was evaluated through the funnel plot with trim and fill method, Egger's test, and by the rank correlation test. Ten studies (2 randomized and 8 non-randomized/5,914 patients with EGC or dysplasia) were identified and analyzed. Overall, the Helicobacter pylori eradication group showed a RR of 0.467 (95% CI: 0.362-0.602, P < 0.001) for the development of metachronous gastric cancer after endoscopic resection of EGC. Subgroup analyses showed consistent results. Publication bias was not detected. Helicobacter pylori eradication after endoscopic resection of EGC reduces the occurrence of metachronous gastric cancer.

[1]  I. Choi,et al.  The Association Between Helicobacter pylori Status and Incidence of Metachronous Gastric Cancer After Endoscopic Resection of Early Gastric Cancer , 2014, Helicobacter.

[2]  J. S. Kim,et al.  Eradication of Helicobacter pylori after endoscopic resection of gastric tumors does not reduce incidence of metachronous gastric carcinoma. , 2014, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[3]  S. Jeon,et al.  Failure of Helicobacter pylori eradication and age are independent risk factors for recurrent neoplasia after endoscopic resection of early gastric cancer in 283 patients , 2014, Alimentary pharmacology & therapeutics.

[4]  Ji-hoon Jung,et al.  Effect of Helicobacter pylori Eradication on Metachronous Recurrence After Endoscopic Resection of Gastric Neoplasm , 2014, The American Journal of Gastroenterology.

[5]  H. Jung,et al.  Eradication of Helicobacter pylori reduces metachronous gastric cancer after endoscopic resection of early gastric cancer. , 2013, Hepato-Gastroenterology.

[6]  Gian Franco Gensini,et al.  Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report , 2012, Gut.

[7]  R. Coffey,et al.  Spasmolytic polypeptide-expressing metaplasia (SPEM) in the gastric oxyntic mucosa does not arise from Lgr5-expressing cells , 2011, Gut.

[8]  Nayoung Kim,et al.  CDX1 and CDX2 Expression in Intestinal Metaplasia, Dysplasia and Gastric Cancer , 2011, Journal of Korean medical science.

[9]  Michele Tarsilla.  Cochrane Handbook for Systematic Reviews of Interventions , 2010, Journal of MultiDisciplinary Evaluation.

[10]  A. Stang.  Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses , 2010, European Journal of Epidemiology.

[11]  F. Bazzoli,et al.  Meta-analysis: Can Helicobacter pylori Eradication Treatment Reduce the Risk for Gastric Cancer? , 2009, Annals of Internal Medicine.

[12]  N. Uedo,et al.  Predictive Factors for Metachronous Gastric Cancer in High-Risk Patients after Successful Helicobacter pylori Eradication , 2008, Digestion.

[13]  M. Asaka,et al.  Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial , 2008, The Lancet.

[14]  Xiao-Hua Zhou,et al.  Statistical Methods for Meta‐Analysis , 2008 .

[15]  T. Rokkas,et al.  The Long‐term Impact of Helicobacter pylori Eradication on Gastric Histology: a Systematic Review and Meta‐analysis , 2007, Helicobacter.

[16]  Jun Kato,et al.  Helicobacter pylori eradication reduced the incidence of gastric cancer, especially of the intestinal type , 2007, Alimentary pharmacology & therapeutics.

[17]  M. Asaka,et al.  Eradication of Helicobacter pylori for primary gastric cancer and secondary gastric cancer after endoscopic mucosal resection , 2007, Journal of Gastroenterology.

[18]  M. Tatsuta,et al.  Helicobacter pylori eradication and metachronous gastric cancer after endoscopic mucosal resection of early gastric cancer , 2006 .

[19]  R. Cui,et al.  The changing trends of the incidence of gastric cancer after Helicobacter pylori eradication in Shandong area. , 2005, Chinese journal of digestive diseases.

[20]  S. Leung,et al.  Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. , 2004 .

[21]  F. Song,et al.  Evaluating non-randomised intervention studies. , 2003, Health technology assessment.

[22]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[23]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[24]  J. Sterne,et al.  Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. , 2001, Journal of clinical epidemiology.

[25]  Alex J. Sutton,et al.  Methods for Meta-Analysis in Medical Research , 2000 .

[26]  S Duval,et al.  Trim and Fill: A Simple Funnel‐Plot–Based Method of Testing and Adjusting for Publication Bias in Meta‐Analysis , 2000, Biometrics.

[27]  R. Hunt,et al.  Meta-analysis of the relationship between Helicobacter pylori seropositivity and gastric cancer. , 1998, Gastroenterology.

[28]  B E Dunn,et al.  Helicobacter pylori , 1997, Clinical microbiology reviews.

[29]  G. Smith,et al.  Bias in meta-analysis detected by a simple, graphical test , 1997, BMJ.

[30]  K. Haruma,et al.  Effect of Helicobacter pylori eradication on subsequent development of cancer after endoscopic resection of early gastric cancer. , 1997, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[31]  D. Sackett,et al.  Cochrane Collaboration , 1994, BMJ.

[32]  C. Begg,et al.  Operating characteristics of a rank correlation test for publication bias. , 1994, Biometrics.

[33]  J H Ellenberg,et al.  Selection bias in observational and experimental studies. , 1994, Statistics in medicine.

[34]  Mahesh S. Patel.  An introduction to meta-analysis. , 1989, Health policy.

[35]  P. Correa,et al.  A human model of gastric carcinogenesis. , 1988, Cancer research.

[36]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[37]  T. Moriyama,et al.  Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer. , 2012, Gastrointestinal endoscopy.

[38]  P. Bertazzi,et al.  IARC working group on the evaluation of carcinogenic risks to humans: some industrial chemicals. Lyon, 15-22 February 1994. , 1994, IARC monographs on the evaluation of carcinogenic risks to humans.