H pylori Eradication Benefits Patients With Early Gastric Cancer

Roxanne Nelson, RN, BSN

March 21, 2018

For patients with early gastric cancer, treatment to eradicate Helicobacter pylori infection is  beneficial but does not improve overall survival.  

A large randomized trial from South Korea, where gastric cancer is the most common malignancy, shows that eradication of H pylori infection almost halved the incidence of metachronous gastric cancer compared with patients who received placebo.

The proportion of patients showing improvement in the grade of gastric corpus atrophy from baseline was also significantly higher among those treated for H pylori.

However, H pylori treatment did not improve the rate of overall survival or the incidence of adenoma in these patients.

The findings are published in the March 22 issue of the New England Journal of Medicine.

In an accompanying editorial, Peter Malfertheiner, MD from the Otto von Guericke University Magdeburg and the Ludwig Maximilian University of Munich, both in Germany, notes that that H pylori eradication has been used as a strategy for gastric cancer prevention.

But this current study was conducted in patients who already had early gastric cancer, and "it is a striking finding that H. pylori eradication may still be effective at this stage," he comments.  

Study Details

The study was led by Il Ju Choi, MD, PhD, from the Center for Gastric Cancer, National Cancer Center, Goyang, South Korea, and colleagues. They point out that patients with gastric cancer often develop advanced precancerous changes in gastric mucosa, including glandular atrophy and intestinal metaplasia.

In this study, they set out to find whether eradication of H pylori would prevent metachronous cancer and decrease histologic changes in early gastric cancer.

A total of 470 patients who had undergone endoscopic resection of early gastric cancer or high-grade adenoma were randomly assigned to receive antibiotic treatment for H pylori infection or placebo. The two main study endpoints were (1) the incidence of metachronous gastric cancer as detected on endoscopy at 1 year or later and (2) an improvement from baseline in the grade of glandular atrophy in the gastric corpus lesser curvature at the 3-year follow-up.

There were 396 patients in the modified intention-to-treat analysis population (194 in the treatment group and 202 in the placebo group), and at a median follow-up of 5.9 years, metachronous gastric cancer developed in 14 patients (7.2%) who underwent H pylori eradication vs 27 (13.4%) patients in the placebo group (hazard ratio in the treatment group, 0.26 - 0.94; P = .03).

Of the 327 patients who had biopsy specimens at 3 years, improvements in the grade of atrophy in the corpus lesser curvature were higher among treated patients than the placebo group (48.4% vs. 15.0% [P < .001]; odds ratio for treatment vs placebo, 5.30).

The proportion of patients who experienced improvement in the grade of intestinal metaplasia at the same site was also higher in the treatment than in the placebo group (36.6% vs 18.3%; P < .001), although grade did not significantly differ between groups for glandular atrophy or intestinal metaplasia at the antrum.

In terms of secondary outcomes, H pylori eradication had less of a benefit. The authors observed that the development of adenomas was nearly identical in both groups: 16 patients in the treatment group and 17 in the placebo group.

Overall survival was also not affected. Death from any cause was reported in 11 patients in the treatment group vs 6 receiving placebo (hazard ratio, 1.95; P = .19). In the treatment group, 1 patient died of gastric cancer, 6 of other organ cancers, and 4 of causes other than cancer in the treatment group; among placebo patients, 1 died of gastric cancer, 1 of colon cancer, and 4 of noncancer causes.

The study was supported by grants from the National Cancer Center, South Korea. The study authors have disclosed no relevant financial relationships.

N Engl J Med. 2018;378:1085-1095. Abstract, Editorial

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