Diabetes History and Gastric Cancer Risk: Different Results by Types of Follow-Up Studies

Objective:

The previous systematic reviews evaluating the association between diabetes history and gastric cancer risk showed inconsistent results. The aim was to check through a meta-epidemiological study that the conclusions of systematic reviews evaluating the association between diabetes history and gastric cancer risk might differ by the type of follow-up study.

Methods:

The potential study subjects were follow-up studies selected from the seven systematic reviews obtained by searching PubMed using diabetes and gastric cancer keywords. The selection criterion was defined as a follow-up study for evaluating the association between the history of type 2 diabetes mellitus and the incidence of gastric cancer. And the values of RR and its 95%CI, which adjusted for the most confounders in each paper, were extracted for meta-analysis. A random-effects model meta-analysis by types of the follow-up study and sex group was performed.

Results:

A total of 25 follow-up studies were finally selected for meta-analysis. They were classified into 16 retrospective and 9 prospective studies in types of follow-up study. The statistical significance between diabetes history and gastric cancer risk was found in retrospective studies (sRR=1.17, 95%CI: 1.02-1.34, I-squared =91.0%) but disappeared in prospective studies (sRR=1.09, 95%CI: 0.91-1.29, I-squared = 68.6%). Even in the analysis of subgroups by sex, statistical significance was not found in the prospective study, consistently.

Conclusion:

The main reason for the previous meta-analysis’s diverse results for the association between diabetes history and gastric cancer risk was that the type of follow-up study was not reflected. According to the meta-analysis of prospective cohort studies, it could be concluded that there is no association between diabetes history and gastric cancer risk.

Host Genetic Determinants Associated With Helicobacter pylori Eradication Treatment Failure: A Systematic Review and Meta-analysis

BACKGROUND & AIMS

Helicobacter pylori infects approximately 50% of individuals worldwide. Successful H pylori eradication is associated with reduced risk of gastric cancer and peptic ulcer disease, among other conditions. We hypothesized that host genetic determinants, especially those affecting gastric pH, might contribute to eradication therapy failure, particularly when treatment adherence and antibiotic susceptibility are confirmed. We aimed to conduct a meta-analysis of host genetic variants associated with H pylori eradication failure.

METHODS

We searched the literature for studies comparing posttreatment H pylori eradication failure vs success (outcome) according to host genetic polymorphisms (exposure). Reference groups were defined according to genotypes (or corresponding phenotypes) hypothesized to be associated with successful eradication. We pooled estimates using a random-effects model and performed comprehensive sensitivity analyses.

RESULTS

We analyzed 57 studies from 11 countries; the vast majority analyzed CYP2C19 polymorphisms. Among individuals prescribed eradication regimens with proton pump inhibitors predominantly CYP2C19 metabolized, enhanced vs poor metabolizer phenotypes were associated with a 2.52-fold significantly higher likelihood of eradication failure and 4.44-fold significantly higher likelihood when treatment adherence and H pylori clarithromycin susceptibility (if relevant) were confirmed. There was no association between CYP2C19 variants and eradication failure if proton pump inhibitors less metabolized by or that bypass CYP2C19 metabolism were used. IL1B polymorphisms that are vs are not associated with less gastric acid suppression were associated with 1.72-fold significantly higher likelihood of eradication failure. There was no association between MDR1 polymorphisms and H pylori eradication failure. The certainty of evidence was moderate.

CONCLUSION

Based on meta-analysis, we identified host genetic polymorphisms significantly associated with H pylori eradication failure; host genetics might underlie eradication failure among treatment-adherent individuals with confirmed H pylori antibiotic susceptibility.

Laparoscopic-Assisted Natural Orifice Specimen Extraction Gastrectomy Using an Auxiliary Incision-free Tube for Gastric Cancer

BACKGROUND

Laparoscopic-assisted natural orifice specimen extraction (LA-NOSE) gastrectomy effectively avoids the need for an abdominal incision, unlike conventional laparoscopic gastrectomy. In this study, we documented our experience with LA-NOSE gastrectomy using an auxiliary incision-free tube (Cai tube, a homemade invention: ZL201410168748.2) in 9 gastric cancer patients and summarized the clinical results.

METHODS

From July 2018 to June 2020, a total of 9 patients with gastric cancer were recruited for this study. LA-NOSE gastrectomy (subtotal or total) using the auxiliary incision-free tube and D₂ lymph node dissection were performed. Specimens were extracted through the anterior wall of the upper rectum in 4 male patients and the posterior fornix of the vagina in 5 female patients using the auxiliary incision-free tube.

RESULTS

All 9 patients underwent successful laparoscopic gastrectomy with NOSE using the auxiliary incision-free tube. No perioperative death, re-admission within 60 days post operation, natural orifice wound infection or tumor implantation was observed. The mean operating time was 365.3±41.7 min, and the mean estimated blood loss was 87.8±39.3 ml. The mean duration of hospital stay was 11.3±1.2 days, while the mean maximum pain score (visual analogue score, VAS) was 2.3±0.9 on postoperative day (POD) 1, and the mean time to ambulation was 1.3±0.5 days. The 60-day postoperative morbidity rate was 11.1% (1/9). After a mean follow-up of 14.7±9.6 months, there was no transrectal or transvaginal access-site recurrence, no anterior rectectomy or posterior fornix colpotomy-related complications, and no local recurrence or distant metastasis.

CONCLUSIONS

Our preliminary experience indicates that this new technique, LA-NOSE gastrectomy using the auxiliary incision-free tube, is feasible for selected patients with gastric cancer.

A second reported malignancy in a patient with Morquio syndrome

Morquio syndrome is a rare lysosomal storage disease that affects multiple organ systems. However, it is rarely associated with malignancy. We present the case of a 30-year old man with Morquio syndrome associated with gastric adenocarcinoma. This case also demonstrates two other findings that have not been previously described in patients with Morquio syndrome - malrotation of brainstem and cerebellum, without clinical neurologic deficit, and persistence of fetal lobulation in the kidneys.

[Survival of Gastric Cancer in Western Honduras Pilot study: 2002-2012]

BACKGROUND

Gastric cancer is the second leading cause of cancer death globally. In Honduras the incidence in the last decade was 39 and 21 per 100,000 inhabitants for men and women, respectively. In 2008 IARC (GLOBOCAN) placed Honduras as the country with the highest incidence of gastric cancer in Latin America.

METHODS

A retrospective cohort study of patients diagnosed with gastric cancer at the Hospital de Occidente between 2002-2012 was designed. A sample of 144 patients was selected from a total of 490 to obtain a confidence level of 95%. The data collection was obtained by verbal autopsy. Prognostic factors of survival were analyzed using Cox proportional hazards ratio models (CI: 95%).

OUTCOMES

The male/female ratio was 2.8:1. The mean age was 63.29 years. Overall five-year survival was 9.39%. Among patients receiving dual therapy (surgery and chemotherapy), a statistically significant increase in survival was found (10.42%, p=0.048). Between the proximal (28.95%) and distal (56.58%) locations also a statistically significant difference was observed (p=0.03). There was no statistically significant difference in the macroscopic (Borrmann) and microscopic findings (Lauren).

DISSCUSION

This study represents the first effort to estimate survival of gastric cancer in Honduras. Survival may be linked to the location of the primary lesion and the type of treatment. It is expected to develop studies with greater coverage, to answer these questions.

Eradication of Helicobacter pylori after endoscopic resection of gastric tumors does not reduce incidence of metachronous gastric carcinoma

BACKGROUND & AIMS

It is not clear whether eradication of Helicobacter pylori infection reduces the risk for metachronous gastric carcinoma. We performed a prospective, randomized, open-label trial of the effects of H pylori eradication on the incidence of metachronous carcinoma after endoscopic resection of gastric tumors.

METHODS

From April 2005 through February 2011 there were 901 consecutive patients with H pylori infection who had been treated with endoscopic resection for gastric dysplasia or cancer and who were assigned randomly to groups given therapy to eradicate the infection (n = 444) or no therapy (controls, n = 457). The eradication group received 20 mg omeprazole, 1 g amoxicillin, and 500 mg clarithromycin twice daily for 1 week. Patients underwent endoscopic examination 3, 6, and 12 months after treatment, and then yearly thereafter. The primary outcome was development of metachronous gastric carcinoma.

RESULTS

During a median follow-up period of 3 years, 10 patients who received H pylori eradication and 17 controls developed metachronous carcinoma; this difference was not significant (P = .15). The incidence of metachronous carcinoma between the 2 groups did not differ significantly at 1, 2, 3, and 4 years after administration of the therapy. There were no significant differences in the development of metachronous carcinoma among patients who were positive (n = 16) or negative (n = 11) for H pylori infection (P = .32).

CONCLUSIONS

In this prospective trial, eradication of H pylori after endoscopic resection of gastric tumors did not significantly reduce the incidence of metachronous gastric carcinoma. ClinicalTrials.gov Number: NCT01510730.