幽门螺杆菌根除对早期胃癌患者内镜黏膜下剥离术后发生异时性癌的影响

Impact of helicobacter pylori eradication on metachronous gastric cancer after endoscopic submucosal dissection of patients with early gastric cancer

摘要:

目的 探索幽门螺杆菌（Hp）根除对早期胃癌患者内镜黏膜下剥离术（ESD）后发生异时性癌（MGC）的影响。方法 回顾性分析2015年1月－2021年5月该院471例行ESD治疗，术后病理证实为早期胃癌及癌前病变的患者的临床资料。根据患者Hp感染及根除情况分为3组，Hp阳性且根除转阴者为Hp根除成功组，Hp未根除及根除未转阴者为Hp根除失败组，Hp阴性者为Hp阴性组，对3组患者ESD术后MGC的发生情况及其危险因素进行统计分析。结果 早期胃癌患者ESD术后MGC 39例（8.3%），Kaplan-Meier分析结果显示：Hp根除成功可明显降低早期胃癌ESD术后MGC风险（χ² = 52.47，P = 0.000），中位随访时间39.0个月。Cox多因素分析结果显示：Hp根除失败（HR＾ = 4.884，95%CI：2.170～10.992，P = 0.000）、年龄 ≥ 60岁（HR＾ = 1.050，95%CI：1.006～1.096，P = 0.025）和饮酒（HR＾ = 3.629，95%CI：1.769～7.444，P = 0.000）是早期胃癌ESD术后发生MGC的独立危险因素。结论 Hp有效根除可降低早期胃癌患者ESD术后MGC的发生风险，年龄和饮酒为发生MGC的独立危险因素，可基于互联网途径加强患者术后管理，以提高患者Hp根除治疗依从性，养成良好的生活习惯。

Abstract:

Objective To explore the effect of Helicobacter pylori (Hp) eradication to prevent the metachronous gastric cancer (MGC) for patients with early gastric cancer treated with endoscopic submucosal dissection (ESD).Methods Clinical data of 471 patients with early gastric cancer and precancerous lesions confirmed by postoperative pathology after ESD from January 2015 to May 2021 were retrospectively analyzed. According to the situation of Hp infection and eradication, patients were divided into three groups. The patients with Hp infection and successful eradication were enrolled into Hp successful eradication group, those without eradication or failed eradication were enrolled into Hp failed eradication group, those with Hp negative were enrolled into Hp negative group. And then the occurrence and risk factors of MGC after ESD among the three groups were statistically analyzed.Results MGC were detected in 39 (8.3%) in patients with early gastric cancer after ESD. Kaplan-Meier analysis showed that successful eradication of Hp significantly reduced the risk of MGC after ESD for early gastric cancer (χ² = 52.47, P = 0.000), and the median follow-up time was 39.0 months. Cox multivariate analysis showed that Hp eradicated failed (HR＾ = 4.884, 95%CI: 2.170~10.992, P = 0.000), age ≥ 60 (HR＾ = 1.050, 95%CI: 1.006 ~ 1.096, P = 0.025) and alcohol consumption (HR＾ = 3.629, 95%CI: 1.769 ~ 7.444, P = 0.000) were independent risk factors for MGC after ESD of early gastric cancer.Conclusion Effective eradication of Hp can reduce the risk of MGC after ESD in patients with early gastric cancer, age and alcohol consumption are independent influencing factors of MGC and postoperative management of patients can be strengthened based on the Internet to improve Hp eradication compliance and the formation of good living habits.