783 H. pylori Infection Is As Important in Proximal As in Distal Gastric Cancer

Bornschein, Jan; Selgrad, Michael; Warnecke, Maren; Kuester, Doerthe; Wex, Thomas; Malfertheiner, Peter

doi:10.1016/s0016-5085(09)60553-9

Cited by 1 publication

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“…This predominant intestinal histological subtype is similar to that reported in oesophageal adenocarcinoma (Reid et al, 2010) and supports an aetiological resemblance with the latter. Taking into account that this is the first study from a European high-risk setting exploring the similarities between cardia and distal stomach cancers using the characteristics of the nonneoplastic mucosa to distinguish subtypes of cardia cancer that are aetiologically different, our results are consistent with the three earlier reports on this subject (Hansen et al, 2007;Derakhshan et al, 2008;Bornschein et al, 2010).…”

Section: Discussionsupporting

confidence: 90%

“…Our study and those by Hansen et al (2007) and Derakhshan et al (2008) relied on similar criteria to define tumour location (Percy et al, 1990), while Bornschein et al (2010) applied a different set of criteria (Siewert and Stein, 1998) to define 'proximal' tumours. The latter, however, excluded the tumours with a more proximal origin and included those located in the fundus or in the proximal third of the corpus, which may have contributed to a higher homogeneity between the proximal and distal tumours with regard to H. pylori infection, presence of atrophy in the nonneoplastic mucosa and tumour histological type.…”

Section: Discussionmentioning

confidence: 99%

“…The observation of a positive association with gastric atrophy (Zhang et al, 1999;Ye et al, 2004;Palli et al, 2007), despite no overall relation with H. pylori infection, supports the coexistence of two aetiologically distinct types of cardia cancer (Hansen et al, 2007;Derakhshan et al, 2008;Bornschein et al, 2010), one associated with H. pylori-induced atrophic gastritis, aetiologically similar to noncardia cancer, more frequent in populations with higher overall gastric cancer incidence; and the other arising in nonatrophic gastric mucosa, associated with acid/ bile-induced damage to the distal oesophagus, resembling oesophageal adenocarcinoma, and likely to have a higher relative frequency in settings with low gastric cancer risk.…”

Section: Introductionmentioning

confidence: 93%

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The coexistence of two aetiologically distinct types of cardia cancer, with distinctive histological characteristics of the neoplastic and nonneoplastic gastric mucosa, may explain the heterogeneous evidence of its association with Helicobacter pylori infection. We compared gastric cardia and noncardia cancers with regard to the frequency of H. pylori infection, the histological characteristics of the nonneoplastic gastric mucosa and the tumour histological type. We evaluated 41 cardia and 339 noncardia cancer cases undergoing gastrectomy, and 380 community controls. H. pylori infection and CagA infection status were assessed by enzyme-linked immunosorbent assay and western blot, respectively. Histological characteristics of the neoplastic and nonneoplastic mucosa were obtained from pathology reports. The association between infection and cancers with different location was quantified in a case-control analysis and cardia and noncardia cancers were further compared. No positive relation was found for H. pylori infection, but CagA-positive strains were associated with an increased risk of noncardia cancer (odds ratio=1.60, 95% confidence interval=1.17-2.18). Twenty-seven (65.8%) cardia cancer cases, predominantly of the intestinal type (66.7%), had nonneoplastic atrophic mucosa and 208 (61.4%) noncardia cancers (56.7% of the intestinal type). Among the cases occurring in nonatrophic patients, the proportion of cancers of the Laurén's intestinal type was 71.4% for cardia and 54.2% for noncardia gastric cancers. Cardia and noncardia cancers were similar with regard to the relation with infection, histological type and condition of the nonneoplastic mucosa, supporting the predominance of cardia cancers determined by H. pylori infection in this European high-risk setting.

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