| Objective:Helicobacter pylori(H.pylori)is recognized as type I carcinogen of gastric cancer(GC).Eradication of H.pylori can effectively reduce the risk of GC development.However,GC still occurs after eradication of H.pylori.Careful endoscopic follow-up is still required after successful eradication of H.pylori.Due to the regression of gastric mucosal inflammation and changes of the background mucosa after H.pylori eradication,the endoscopic features and histopathology of early gastric cancer(EGC)after H.pylori eradication are different from those of traditional EGC,and the diagnosis is more difficult.This study collected cases of early gastric cancer after H.pylori eradication resected endoscopically from several hospitals in Shandong Province,supplemented by metaanalysis,and summarized their clinical features,endoscopic findings,and histopathological features to help accurately identify early gastric cancer after H.pylori eradication,which can improve diagnostic accuracy and avoids missed diagnosis and misdiagnosis.Methods:81 cases of EGC after eradication of H.pylori(abbreviated as eradication group)and105 cases of H.pylori infection-related EGC(abbreviated as control group)as a control resected by endoscopic submucosal dissection(ESD)from January 2015 to March 2022 in the Affiliated Hospital of Qingdao University,Shandong Second Provincial General Hospital,People’s Hospital of Rizhao,and Qingdao Central Hospital of Shandong Province were collected.The clinical features,endoscopic manifestations and histopathological characteristics were analyzed in order to improve the diagnostic accuracy of EGC after H.pylori eradication.The articles about gastric cancer and H.pylori published in Pub Med,Embase,Cochrane Library,CNKI,WANFANG DATA and Sino Med up to September 2021 were searched.The articles containing controlled trials of GC after H.pylori eradication and H.pylori infection-related GC were screened according to the inclusion and exclusion criteria.The data were extracted and compared using Stata15.0,to summarize the clinical and endoscopic features of gastric cancer after H.pylori eradication.Results:1.The age of eradication group ranged from 41 to 81 years,with an average of61.81±9.19,58 males(58/81,71.6%)and 23 females(23/81,28.4%)were in the group.There was no statistically significant difference in age(P=0.616),gender distribution(P=0.479),smoking history(P=0.772),drinking history(P=0.771),family history of GC(P=0.284),past history(P=0.643),and clinical symptoms(P=0.806)between the eradication group and control group.2.More people in the eradication group took proton pump inhibitor(PPI)for more than one year than those in the control group,the difference was statistically significant(P<0.001).3.The degree of mucosal atrophy in the eradication group was significantly more moderate and severe than that in the control group,the difference was statistically significant(P=0.010).In the eradication group,the background mucosa showed map like redness,which was significantly more than that in the control group,the difference was statistically significant(P<0.001).There was no statistically significant difference in the degree of intestinal metaplasia between the two groups(P=0.110).4.The diameter of lesions in eradication group was smaller than those in the control group(P=0.042),and there were more lesions ≤20mm(P=0.039),the difference was statistically significant.The lesions of the two groups are mainly located in the lower part of the stomach,with a clear border and superficial depressed type under endoscopy.There was no statistical difference between the eradication group and control group in terms of lesion location(P=0.730),border(P=0.561),and Paris classification(P=0.393).5.The results of multivariate Logistic regression analysis suggested that taking PPI for more than 1 year(OR=6.919,95%CI 2.696-17.759,P<0.001),moderate to severe mucosal atrophy(OR=2.339,95%CI 1.116-4.903,P=0.024)and mucosal map redness(OR=39.195,95%CI 13.641-112.617,P<0.001)were independent risk factors for EGC after H.pylori eradication.6.There was a significant difference in histopathological classification between the eradication group and the control group(P=0.001).The histopathological classification of the eradication group was mostly high-grade intraepithelial neoplasia(HGIN)(P<0.001).The proportion of well differentiated and moderately differentiated adenocarcinoma was significantly higher than that of the control group(P=0.037).The expression level of Ki67 in the eradication group was relatively lower,and the positive expression rate of Ki67 <50%in the eradication group was higher than that in the control group,the difference was statistically significant(P=0.014).7.In the meta-analysis,the age of onset was older in patients with GC group after H.pylori eradication and those in H.pylori infection-related GC group(95%CI-0.14-0.14,P=0.920),and most of these patients were males(95%CI 0.91-1.71,P=0.545),the difference was not statistically significant.8.In the meta-analysis,most of the GC lesions after H.pylori eradication were located in the middle and lower part of the stomach(95%CI 0.53-1.09,P=0.031),and the lesion was significantly smaller than that in the H.pylori infection-related GC group(95%CI-0.61--0.32,P<0.001).Compared with the H.pylori infection-related GC group,intestinal type was more common in GC group after H.pylori eradication(95%CI 3.75-14.49,P=0.001),the difference was statistically significant.Conclusions:1.Most patients with EGC after H.pylori eradication took PPI for more than 1 year.2.Patients with EGC after H.pylori eradication had severe mucosal atrophy,the background mucosa showed characteristic map redness and the diameter was mostly≤20mm,which was smaller than that of H.pylori infection-related EGC group.3.Taking PPI for more than 1 year,moderate to severe mucosal atrophy and mucosal map redness were independent risk factors for EGC after H.pylori eradication.4.The pathological type of EGC after H.pylori eradication mostly were HGIN.The proportion of well-differentiated or moderately differentiated adenocarcinoma was higher in the EGC after H.pylori eradication group than that of H.pylori infection-related EGC group and the expression level of Ki67 was lower.5.Meta-analysis showed that most lesions of gastric cancer after H.pylori eradication were located in the middle and lower part of the stomach and most were intestinal type. |
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