J Korean Med Sci.  2015 Jun;30(6):749-756. 10.3346/jkms.2015.30.6.749.

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

• Bang CS
• Baik GH
• Shin IS
• Kim JB
• Suk KT
• Yoon JH
• Kim YS
• Kim DJ

• KMID: 2160604
• DOI: http://doi.org/10.3346/jkms.2015.30.6.749

Abstract

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.

Keyword

Stomach Neoplasms; Helicobacter pylori; Metachronous Neoplasms

MeSH Terms

Adult
Aged
Aged, 80 and over
Combined Modality Therapy/statistics & numerical data
Comorbidity
Female
Gastroscopy/*statistics & numerical data
Helicobacter Infections/epidemiology/*prevention & control
Humans
Incidence
Male
Middle Aged
Neoplasms, Second Primary/*epidemiology/pathology/*prevention & control
Risk Factors
Stomach Neoplasms/*epidemiology/pathology/*surgery
Treatment Outcome

Figure

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  Fig. 1 Flow diagram for identification of relevant studies.

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  Fig. 2 Total efficacy of H. pylori eradication for the prevention of metachronous recurrence after endoscopic resection of EGC. H. pylori, Helicobacter pylori; EGC, early gastric cancer; ITT, intention-to-treat. The size of each square is proportional to the study's weight. Diamond is the summary estimate from the pooled studies (random effect model, including studies with ITT analysis).

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  Fig. 3 RoB table for the assessment of methodological quality for randomized studies. RoB, risk of bias. (+) denotes low risk of bias, (-) denotes high risk of bias, (?) denotes unclear risk of bias.

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  Fig. 4 Funnel plot for publication bias (including studies with ITT analysis). ITT, Intention-to-treat. Funnel plot of studies. The line in center is the natural logarithm of pooled RR, and 2 oblique lines are pseudo 95% confidence limits. RR: risk ratio.

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