韩国国立癌症中心Il Ju Choi研究小组近日取得一项新成果。经过不懈努力，他们对胃癌家族史患者接受幽门螺杆菌的治疗的患癌风险进行了分析。这一研究成果于2020年1月30日发表在国际顶尖学术期刊《新英格兰医学杂志》上。

幽门螺杆菌感染和胃癌家族史是胃癌的主要危险因素。根除幽门螺杆菌的治疗是否能降低一级亲属中有胃癌家族史的人患胃癌的风险仍不清楚。

在这项单中心、双盲、安慰剂对照的试验中，研究组筛选了3100名胃癌患者的一级亲属。将其中1838名幽门螺杆菌感染者随机分组，分别接受兰索拉唑+阿莫西林+克拉霉素的根除治疗或安慰剂治疗。

共有1676名受试者被纳入最终分析，其中治疗组832名，安慰剂组844名。中位随访9.2年后，治疗组中有10名受试者（1.2%）发生胃癌，安慰剂组中有23名（2.7%），风险比为0.45。10名胃癌患者中有5名患持续性幽门螺杆菌感染。根除了幽门螺杆菌感染的受试者中有0.8%的患者发生胃癌，而持续感染的受试者中胃癌发生率为2.9%，风险比为0.27。治疗组中不良事件发生率为53.0%，显著高于安慰剂组（19.1%），但均较轻微。

总之，对于有一级亲属胃癌家族史的幽门螺杆菌感染者，根除幽门螺杆菌治疗可降低胃癌风险。

附：英文原文

Title: Family History of Gastric Cancer and Helicobacter pylori Treatment

Author: Il Ju Choi, M.D., Ph.D.,, Chan Gyoo Kim, M.D., Ph.D.,, Jong Yeul Lee, M.D.,, Young-Il Kim, M.D.,, Myeong-Cherl Kook, M.D., Ph.D.,, Boram Park, Ph.D.,, and Jungnam Joo, Ph.D.

Issue&Volume: 2020-01-29

Abstract:

Background
Helicobacter pylori infection and a family history of gastric cancer are the main risk factors for gastric cancer. Whether treatment to eradicate H. pylori can reduce the risk of gastric cancer in persons with a family history of gastric cancer in first-degree relatives is unknown.

Methods
In this single-center, double-blind, placebo-controlled trial, we screened 3100 first-degree relatives of patients with gastric cancer. We randomly assigned 1838 participants with H. pylori infection to receive either eradication therapy (lansoprazole [30 mg], amoxicillin [1000 mg], and clarithromycin [500 mg], each taken twice daily for 7 days) or placebo. The primary outcome was development of gastric cancer. A prespecified secondary outcome was development of gastric cancer according to H. pylori eradication status, assessed during the follow-up period.

Results
A total of 1676 participants were included in the modified intention-to-treat population for the analysis of the primary outcome (832 in the treatment group and 844 in the placebo group). During a median follow-up of 9.2 years, gastric cancer developed in 10 participants (1.2%) in the treatment group and in 23 (2.7%) in the placebo group (hazard ratio, 0.45; 95% confidence interval [CI], 0.21 to 0.94; P=0.03 by log-rank test). Among the 10 participants in the treatment group in whom gastric cancer developed, 5 (50.0%) had persistent H. pylori infection. Gastric cancer developed in 0.8% of participants (5 of 608) in whom H. pylori infection was eradicated and in 2.9% of participants (28 of 979) who had persistent infection (hazard ratio, 0.27; 95% CI, 0.10 to 0.70). Adverse events were mild and were more common in the treatment group than in the placebo group (53.0% vs. 19.1%; P<0.001).

Conclusions
Among persons with H. pylori infection who had a family history of gastric cancer in first-degree relatives, H. pylori eradication treatment reduced the risk of gastric cancer.

DOI: NJ202001303820507

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1909666