Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2020; 26(15): 1820-1840
Published online Apr 21, 2020. doi: 10.3748/wjg.v26.i15.1820
Chemoprevention of gastric cancer development after Helicobacter pylori eradication therapy in an East Asian population: Meta-analysis
Mitsushige Sugimoto, Masaki Murata, Yoshio Yamaoka
Mitsushige Sugimoto, Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Sinjuku, Tokyo 1600023, Japan
Masaki Murata, Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto 6128555, Japan
Yoshio Yamaoka, Department of Gastroenterology, Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Oita 8795593, Japan
Author contributions: Sugimoto M acquisition of data, analysis and interpretation of data, drafting the article, final approval; Murata M acquisition of data, analysis and interpretation of data, final approval; Yoshioka Y design of the study, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: This study was conducted according to the PRISMA agreement reporting guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Mitsushige Sugimoto, MD, PhD, AGAF, Professor, Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 1600023, Japan. sugimo@tokyo-med.ac.jp
Received: December 16, 2019
Peer-review started: December 16, 2019
First decision: January 7, 2020
Revised: March 15, 2020
Accepted: April 1, 2020
Article in press: April 1, 2020
Published online: April 21, 2020
Processing time: 126 Days and 18.8 Hours
Abstract
BACKGROUND

Helicobacter pylori (H. pylori) infection is a risk factor for gastric cancer (GC), especially in East Asian populations. Most East Asian populations infected with H. pylori are at higher risk for GC than H. pylori-positive European and United States populations. H. pylori eradication therapy reduces gastric cancer risk in patients after endoscopic and operative resection for GC, as well as in non-GC patients with atrophic gastritis.

AIM

To clarify the chemopreventive effects of H. pylori eradication therapy in an East Asian population with a high incidence of GC.

METHODS

PubMed and the Cochrane library were searched for randomized control trials (RCTs) and cohort studies published in English up to March 2019. Subgroup analyses were conducted with regard to study designs (i.e., RCTs or cohort studies), country where the study was conducted (i.e., Japan, China, and South Korea), and observation periods (i.e., ≤ 5 years and > 5 years). The heterogeneity and publication bias were also measured.

RESULTS

For non-GC patients with atrophic gastritis and patients after resection for GC, 4 and 4 RCTs and 12 and 18 cohort studies were included, respectively. In RCTs, the median incidence of GC for the untreated control groups and the treatment groups was 272.7 (180.4–322.4) and 162.3 (72.5–588.2) per 100000 person-years in non-GC cases with atrophic gastritis and 1790.7 (406.5–2941.2) and 1126.2 (678.7–1223.1) per 100000 person-years in cases of after resection for GC. Compared with non-treated H. pylori-positive controls, the eradication groups had a significantly reduced risk of GC, with a relative risk of 0.67 [95% confidence interval (CI): 0.47–0.96] for non-GC patients with atrophic gastritis and 0.51 (0.36–0.73) for patients after resection for GC in the RCTs, and 0.39 (0.30–0.51) for patients with gastritis and 0.54 (0.44–0.67) for patients after resection in cohort studies.

CONCLUSION

In the East Asian population with a high risk of GC, H. pylori eradication effectively reduced the risk of GC, irrespective of past history of previous cancer.

Keywords: Helicobacter pylori; Eradication therapy; Gastric cancer; Metachronous cancer; East Asia; Prevention

Core tip: No meta-analysis is available in the literature about the chemopreventive effects of Helicobacter pylori eradication therapy on the incidence of gastric cancer (GC) focused on East Asian populations living in geographical areas with high incidences of GC. We conducted a meta-analysis to reevaluate the prevention of Helicobacter pylori eradication therapy on the incidence of GC, irrespective of history of endoscopic or surgical treatment for GC.