Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2015; 21(16): 4954-4960
Published online Apr 28, 2015. doi: 10.3748/wjg.v21.i16.4954
Characteristics of gastric cancer in peptic ulcer patients with Helicobacter pylori infection
Jae Jin Hwang, Dong Ho Lee, Ae-Ra Lee, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Nayoung Kim
Jae Jin Hwang, Dong Ho Lee, Ae-Ra Lee, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Nayoung Kim, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do 463-707, South Korea
Author contributions: Hwang JJ and Lee DH were responsible for the study conception and design, data analysis and interpretation, and manuscript drafting; Lee A, Yoon H, Shin CM, Park YS and Kim N critically revised the article for important intellectual content; all the authors reviewed and approved the final version to be published.
Ethics approval: The study was reviewed and approved by the Seoul National University Bundang Hospital Institutional Review Board.
Conflict-of-interest: All the authors declare no potential conflicting interests related to this paper.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong Ho Lee, MD, Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do 463-707, South Korea. dhljohn@yahoo.co.kr
Telephone: + 82-31-7877006 Fax: + 82-31-7874051
Received: October 15, 2014
Peer-review started: October 15, 2014
First decision: November 14, 2014
Revised: November 26, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: April 28, 2015
Processing time: 194 Days and 8.7 Hours
Abstract

AIM: To evaluate the incidence and clinical characteristics of gastric cancer (GC) in peptic ulcer patients with Helicobacter pylori (H. pylori) infection.

METHODS: Between January 2003 and December 2013, the medical records of patients diagnosed with GC were retrospectively reviewed. Those with previous gastric ulcer (GU) and H. pylori infection were assigned to the HpGU-GC group (n = 86) and those with previous duodenal ulcer (DU) disease and H. pylori infection were assigned to the HpDU-GC group (n = 35). The incidence rates of GC in the HpGU-GC and HpDU-GC groups were analyzed. Data on demographics (age, gender, peptic ulcer complications and cancer treatment), GC clinical characteristics [location, pathological diagnosis, differentiation, T stage, Lauren’s classification, atrophy of surrounding mucosa and intestinal metaplasia (IM)], outcome of eradication therapy for H. pylori infection, esophagogastroduodenoscopy number and the duration until GC onset were reviewed. Univariate and multivariate analyses were performed to identify factors influencing GC development. The relative risk of GC was evaluated using a Cox proportional hazards model.

RESULTS: The incidence rates of GC were 3.60% (86/2387) in the HpGU-GC group and 1.66% (35/2098) in the HpDU-GC group. The annual incidence was 0.41% in the HpGU-GC group and 0.11% in the HpDU-GC group. The rates of moderate-to-severe atrophy of the surrounding mucosa and IM were higher in the HpGU-GC group than in the HpDU-GC group (86% vs 34.3%, respectively, and 61.6% vs 14.3%, respectively, P < 0.05). In the univariate analysis, atrophy of surrounding mucosa, IM and eradication therapy for H. pylori infection were significantly associated with the development of GC (P < 0.05). There was no significant difference in the prognosis of GC patients between the HpGU-GC and HpDU-GC groups (P = 0.347). The relative risk of GC development in the HpGU-GC group compared to that of the HpDU-GC group, after correction for age and gender, was 1.71 (95%CI: 1.09-2.70; P = 0.02).

CONCLUSION: GU patients with H. pylori infection had higher GC incidence rates and relative risks. Atrophy of surrounding mucosa, IM and eradication therapy were associated with GC.

Keywords: Gastric cancer; Gastric ulcer; Duodenal ulcer; Helicobacter pylori; Eradication therapy

Core tip: This is the first study to investigate gastric cancer (GC) incidence in peptic ulcer patients with Helicobacter pylori (H. pylori) infection and to compare GC clinical characteristics between patients with gastric ulcer (GU) and duodenal ulcer (DU) disease. The GC incidence rate and relative risk in GU patients with H. pylori infection were higher than in DU patients. The H. pylori eradication rate was lower in GU than in DU patients, although the success rate of therapy was lower than the failure rate in both groups. Atrophy of surrounding mucosa, intestinal metaplasia and H. pylori eradication therapy were significantly associated with GC.