Effects of Helicobacter pylori treatment on gastric cancer incidence and mortality in subgroups
Li, W-Q., Ma, J-L., Zhang, L., Brown, L. M., Li, J-Y., Shen, L., Pan, K-F., Liu, W-D., Hu, Y., Han, Z-X., Crystal-Mansour, S., Pee, D., Blot, W. J., Fraumeni, J. F., You, W-C., & Gail, M. H. (2014). Effects of Helicobacter pylori treatment on gastric cancer incidence and mortality in subgroups. Journal of the National Cancer Institute, 106(7), Article dju116. https://doi.org/10.1093/jnci/dju116
Among 2258 Helicobacter pylori-seropositive subjects randomly assigned to receive one-time H. pylori treatment with amoxicillin-omeprazole or its placebo, we evaluated the 15-year effect of treatment on gastric cancer incidence and mortality in subgroups defined by age, baseline gastric histopathology, and post-treatment infection status. We used conditional logistic and Cox regressions for covariable adjustments in incidence and mortality analyses, respectively. Treatment was associated with a statistically significant decrease in gastric cancer incidence (odds ratio = 0.36; 95% confidence interval [CI] = 0.17 to 0.79) and mortality (hazard ratio = 0.26; 95% CI = 0.09 to 0.79) at ages 55 years and older and a statistically significant decrease in incidence among those with intestinal metaplasia or dysplasia at baseline (odds ratio = 0.56; 95% CI = 0.34 to 0.91). Treatment benefits for incidence and mortality among those with and without post-treatment infection were similar. Thus H. pylori treatment can benefit older members and those with advanced baseline histopathology, and benefits are present even with post-treatment infection, suggesting treatment can benefit an entire population, not just the young or those with mild histopathology.