NEJM:根除幽门螺杆菌降低胃癌风险
创作:王文东 审核:Lexi 03月01日
  • 纳入1676名患有幽门螺杆菌感染的胃癌患者一级亲属,832名接受幽门螺杆菌(H. pylori)根除治疗,844名为安慰剂组;
  • 在9.2年中位随访期间,治疗组和安慰剂组分别有10人(1.2%)和23人(2.7%)发生胃癌,危险比0.45;
  • 治疗组发生胃癌的10例患者中,5例具有持续性H. pylori感染;
  • 根除H. pylori感染的608人中,5人(0.8%)发生胃癌,持续性感染的979人中,28人(2.9%)发生胃癌,危险比0.27;
  • 不良事件轻微,在治疗组中比安慰剂组更常见。
主编推荐语
Lexi
幽门螺杆菌(H. pylori)感染和胃癌家族史是胃癌的主要危险因素,根除H. pylori的治疗是否能降低一级亲属中有胃癌家族史的人患胃癌的风险尚不清楚。最近发表在New England Journal of Medicine的研究纳入1676名患有幽门螺杆菌感染的胃癌患者一级亲属,接受H. pylori根除治疗或安慰剂。该研究发现,在一级亲属有胃癌家族史的H. pylori感染者中,根除H. pylori治疗降低了胃癌的风险。
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Family History of Gastric Cancer and Helicobacter pylori Treatment

胃癌家族史和幽门螺杆菌治疗

10.1056/NEJMoa1909666

01-30, Article

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BACKGROUND: Helicobacter pylori infection and a family history of gastric cancer are the main risk factors for gastric cancer. Whether treatment to eradicate H. pylori can reduce the risk of gastric cancer in persons with a family history of gastric cancer in first-degree relatives is unknown.
METHODS: In this single-center, double-blind, placebo-controlled trial, we screened 3100 first-degree relatives of patients with gastric cancer. We randomly assigned 1838 participants with H. pylori infection to receive either eradication therapy (lansoprazole [30 mg], amoxicillin [1000 mg], and clarithromycin [500 mg], each taken twice daily for 7 days) or placebo. The primary outcome was development of gastric cancer. A prespecified secondary outcome was development of gastric cancer according to H. pylori eradication status, assessed during the follow-up period.
RESULTS: A total of 1676 participants were included in the modified intention-to-treat population for the analysis of the primary outcome (832 in the treatment group and 844 in the placebo group). During a median follow-up of 9.2 years, gastric cancer developed in 10 participants (1.2%) in the treatment group and in 23 (2.7%) in the placebo group (hazard ratio, 0.45; 95% confidence interval [CI], 0.21 to 0.94; P=0.03 by log-rank test). Among the 10 participants in the treatment group in whom gastric cancer developed, 5 (50.0%) had persistent H. pylori infection. Gastric cancer developed in 0.8% of participants (5 of 608) in whom H. pylori infection was eradicated and in 2.9% of participants (28 of 979) who had persistent infection (hazard ratio, 0.27; 95% CI, 0.10 to 0.70). Adverse events were mild and were more common in the treatment group than in the placebo group (53.0% vs. 19.1%; P<0.001).
CONCLUSIONS: Among persons with H. pylori infection who had a family history of gastric cancer in first-degree relatives, H. pylori eradication treatment reduced the risk of gastric cancer. (Funded by the National Cancer Center, South Korea; ClinicalTrials.gov number, NCT01678027. opens in new tab.)

First Authors:
Il Ju Choi

Correspondence Authors:
Il Ju Choi

All Authors:
Il Ju Choi,Chan Gyoo Kim,Jong Yeul Lee,Young‑Il Kim,Myeong‑Cherl Kook,Boram Park,Jungnam Joo

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Nature Reviews Gastroenterology and Hepatology期刊

H. pylori elimination reduces gastric cancer risk

2020-02-21

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