Published online Sep 16, 2020. doi: 10.4253/wjge.v12.i9.276
Peer-review started: June 10, 2020
First decision: July 21, 2020
Revised: July 29, 2020
Accepted: August 15, 2020
Article in press: August 15, 2020
Published online: September 16, 2020
Processing time: 91 Days and 23.7 Hours
With the spread of eradication therapy for Helicobacter pylori (H. pylori), the number of patients with gastric cancer diagnosed for the first time after eradication therapy is on the rise; therefore, the analysis of these cases would become more important. Recently, Kyoto classification has been devised as a method for evaluation of endoscopic findings of the stomach, and its validity is being studied.
As far as we know, few data exist on the association between Kyoto classification and primary gastric cancer occurrence post H. pylori eradication therapy.
The purpose of this study was to develop Kyoto classification for differentiating between single and multiple gastric cancers in patients diagnosed with gastric cancer after H. pylori eradication.
This retrospective study included 67 patients who were diagnosed with primary gastric cancer at least six months after the successful H. pylori eradication therapy between February 2010 to February 2019 in Toyoshima Endoscopy Clinic. We used data available from clinical charts and endoscopic database. We defined primary gastric cancer as pathologically diagnosed gastric cancer without past gastric neoplasm history. We divided these 67 gastric cancer patients into single gastric cancer patients and multiple gastric cancer patients. We defined multiple gastric cancer patients as those who had synchronous and/or metachronous gastric cancer. Patients without one or more follow-up endoscopy at our institution after primary gastric cancer diagnosis were excluded from the single gastric cancer patient group.
The Kyoto score at the time of diagnosis of 45 cases of gastric cancer after H. pylori eradication was 4.0 points in average. The score was 3.8 points in the single gastric cancer group, and 5.1 points in the multiple gastric cancers group. The multiple group had a significantly higher score than the single group (P = 0.016). In the multiple gastric cancers group, all the patients (7/7) had 5 or higher Kyoto score, while in single gastric cancer group, the proportion of patients with a score of 5 or higher was less than half, or 44.7% (17/38).
Patients diagnosed with gastric cancer after H. pylori eradication tended to have advanced gastritis. In particular, in cases of multiple gastric cancers developed after H. pylori eradication, the endoscopic Kyoto classification score tended to be 5 or higher in patients with an open type atrophic gastritis and the intestinal metaplasia extended to the corpus.
We believe that multiple gastric carcinomas could occur in the situation of so called “point of no return”, in which gastric carcinogenesis cascade had progressed to the advanced stage due to the H. pylori infection; therefore, even the eradication therapy could not repair the molecularly irreversible gastric mucosal changes.