Association between Helicobacter pylori status and metachronous gastric cancer after endoscopic resection

Table 1 Baseline characteristics of patients in the Helicobacter pylori tested group n (%)

	H. pylori	H. pylori	H. pylori	P value
	negative group	persistent group	eradicated group
	(n = 95)	(n = 42)	(n = 120)
Sex
Male	74 (77.9)	29 (69.0)	86 (71.7)	0.454
Female	21 (22.1)	13 (31.0)	34 (28.3)
Age, mean (SD)	68.65 (8.86)	67.31 (9.12)	64.76 (10.10)	0.011
Follow-up period (mo), mean (SD)	36.18 (± 26.74)	33.29 (± 25.93)	32.78 (± 23.72)	0.149
Endoscopic mucosal atrophy	50 (52.6)	8 (19.0)	25 (20.8)	< 0.001
Intestinal metaplasia	63 (66.3)	18 (42.9)	32 (26.7)	< 0.001
Location of primary cancer
Upper	10 (10.5)	5 (11.9)	10 (8.3)	0.577
Middle	36 (37.9)	14 (33.3)	35 (29.2)
Lower	49 (51.6)	23 (54.8)	75 (62.5)
Macroscopic type of primary cancer
Elevated	40 (42.1)	122 (8.6)	57 (47.5)	0.177
Flat	13 (13.7)	5 (11.9)	9 (7.5)
Depressed	42 (37.0)	25 (59.5)	54 (45.0)
Diameter of primary cancer (cm), mean (SD)	14.24 (7.31)	13.83 (6.22)	13.67 (6.90)	0.978
Histology of primary cancer
Differentiated	93 (97.9)	38 (90.5)	118 (98.3)	0.032
Undifferentiated	2 (2.1)	4 (9.5)	2 (1.7)
ESD criteria
Absolute	73 (76.8)	33 (78.6)	95 (79.2)	0.636
Expended	18 (18.9)	5 (11.9)	19 (15.8)
Beyond expanded	4 (4.2)	4 (9.5)	6 (5.0)
Depth of primary cancer
Mucosa	89 (93.7)	40 (95.2)	111 (92.5)	0.819
Submucosa	6 (6.3)	2 (4.8)	9 (7.5)
Metachronous cancer recurrence	7 (7.4)	1 (2.4)	3 (2.5)	0.173

ESD: Endoscopic submucosal dissection; H. pylori: Helicobacter pylori.

Table 2 Baseline characteristics of patients according to performance of Helicobacter pylori status test n (%)

	H. pylori tested group	H. pylori non-tested group	P value
	(n = 257)	(n = 176)
Sex
Male	189 (73.5)	136 (77.3)	0.378
Female	68 (26.5)	40 (22.7)
Age, mean (SD)	66.61 (9.63)	67.60 (10.03)	0.303
Follow-up period (mo), mean (SD)	34.12 (25.19)	33.31 (18.11)	0.699
Endoscopic mucosal atrophy	83 (32.3)	12 (6.8)	< 0.001
Intestinal metaplasia	113 (44.0)	14 (8.0)	< 0.001
Location of primary cancer
Upper	25 (9.7)	12 (6.8)
Middle	85 (33.1)	37 (21.0)	0.006
Lower	147 (57.2)	127 (72.2)
Macroscopic type of primary cancer
Elevated	109 (42.4)	95 (54.0)
Flat	27 (10.5)	24 (13.6)	0.009
Depressed	121 (47.1)	57 (32.4)
Diameter of primary cancer (cm), mean (SD)	13.91 (6.93)	14.30 (5.74)	0.540
Histology of primary cancer
Differentiated	249 (96.9)	171 (97.2)
Undifferentiated	8 (3.1)	5 (2.8)	0.871
ESD criteria
Absolute	201 (78.2)	142 (80.7)	0.234
Expended	42 (16.3)	20 (11.4)
Beyond expanded	14 (5.4)	14 (8.0)
Depth of primary cancer
Mucosa	240 (93.4)	161 (91.5)	0.456
Submucosa	17 (6.6)	15 (8.5)
Metachronous cancer recurrence	11 (4.3)	4 (2.3)	0.262

ESD: Endoscopic submucosal dissection; H. pylori: Helicobacter pylori.

Table 3 Comparisons of clinical characteristics between patients with or without metachronous gastric cancer in all patients n (%)

	Non-metachronous gastric cancer group (n = 418)	Metachronous gastric cancer group (n = 15)	P value
Sex
Male	310 (74.2)	15 (100)	0.028
Female	108 (25.8)	0 (0)
Age, mean (SD)	66.95 (9.82)	68.93 (9.35)	0.441
Location of primary cancer
Upper	35 (8.4)	2 (13.3)	0.163
Middle	115 (27.5)	7 (46.7)
Lower	268 (64.1)	6 (40.0)
Lesion size (cm), mean (SD)	14.01 (6.10)	15.60 (13.48)	0.350
Endoscopic mucosal atrophy	87 (20.8)	8 (53.3)	0.003
Intestinal metaplasia	117 (28.0)	10 (66.7)	0.001
Histology of undifferentiated type	12 (2.9)	1 (6.7)	0.397
SM invasion	31 (7.4)	1 (6.7)	0.913
Non-performance of H. pylori status test	172 (41.1)	4 (26.7)	0.262
Follow-up period (mo), mean period (SD)	33.72 (22.58)	35.60 (22.68)	0.752

SM: Submucosa; H. pylori: Helicobacter pylori.

Table 4 Comparisons of the clinical characteristics of patients with or without matachronous gastric cancer in the Helicobacter pylori tested group n (%)

	Non-metachronous gastric cancer group (n = 246)	Metachronous gastric cancer group (n = 11)	P value
Sex
Male	178 (72.4)	11 (100)	0.042
Female	68 (29.6)	0 (0)
Age, mean (SD)	66.44 (9.66)	70.45 (8.52)	0.177
Location of primary cancer
Upper	24 (9.8)	1 (9.1)	0.290
Middle	79 (32.1)	6 (54.5)
Lower	143 (58.1)	4 (36.4)
Lesion size (cm), mean (SD)	13.75 (6.32)	17.36 (15.45)	0.458
Endoscopic mucosal atrophy	75 (30.5)	8 (72.7)	0.003
Intestinal metaplasia	104 (42.3)	9 (81.8)	0.010
Histology of undifferentiated type	8 (3.3)	0 (0)	0.543
SM invasion	16 (6.5)	1 (9.1)	0.736
Persistent H. pylori infection	41 (16.7)	1 (9.1)	0.173
H. pylori negative	88 (35.8)	7 (63.6)	0.061
Follow-up period (mo), mean (SD)	34.13 (25.30)	33.72 (23.64)	0.958

SM: Submucosa; H. pylori: Helicobacter pylori.

Table 5 Results of univariate and multivariate analysis for factors associated with the development of metachronous gastric cancer in the Helicobacter pylori tested group

	Univariate analysis			Multivariate analysis
	HR	95%CI	P value	HR	95%CI	P value
Age ≥ 65 yr	1.736	0.449-6.705	0.424
Endoscopic mucosal atrophy	6.080	1.569-23.556	0.009	6.080	1.569-23.556	0.009
Intestinal metaplasia	6.144	1.300-29.033	0.022	2.654	0.400-17.621	0.312
Histology of undifferentiated type	0.000	0.000	0.999
SM invasion	1.437	0.173-11.942	0.737
H. pylori negative	3.142	0.895-11.031	0.074	1.638	0.426-6.299	0.473
H. pylori eradication	0.413	0.107-1.595	0.200

SM: Submucosa; H. pylori: Helicobacter pylori.

Table 6 Results of univariate and multivariate analysis for factors associated with the development of metachronous gastric cancer in all patients

	Univariate analysis			Multivariate analysis
	HR	95%CI	P valve	HR	95%CI	P value
Age ≥ 65 yr	1.317	0.442-3.923	0.620
Endoscopic mucosal atrophy	4.348	1.535-12.320	0.006	1.966	0.526-7.351	0.315
Intestinal metaplasia	5.145	1.722-15.373	0.003	5.145	1.722-15.373	0.003
Histology of undifferentiated type	2.417	0.293-19.902	0.412
SM invasion	0.892	0.113-7.007	0.913
H. pylori non-tested	0.520	0.163-1.660	0.270

SM: Submucosa; H. pylori: Helicobacter pylori.