A Meta-analysis Of Preventive Effect Of Helicobacter Pylori Eradication On Metachronous Cancer After Endoscopic Resection For Early Gastric Cancer

Objective The aim of this study was to determine the preventive effect of H.pylori eradication on the development of metachronous gastric cancer(MGC)after endoscopic resection(ER)for patients with early gastric cancer(EGC)by a Meta-analysis of all relevant studies,and provide reference for clinical strategy of H.pylori eradication.Methods Databases including Pub Med?EMBASE?Cochrane Library?Web of Science database were searched from inception to December 2018 and 15 studies(3 prospective randomized trials,1 prospective nonrandomized study and 11 retrospective cohort study)were enrolled into this analysis.We evaluated quality of eligible trials by using Cochrane risk of bias tool for RCT and Newcastle-Ottawa Scale for cohort study.The details of the trial design,characteristics of subjects,results of the studies were reviewed and analyzed by using the STATA 12.1 statistical package.Fixed-effect model and Random-effect model was performed to calculate the effect size.Heterogeneity was assessed with Cochran's Q statistic and I2 test.Galbraith plot test was performed to assess the potential source of heterogeneity.Publication bias were first estimated by funnel plot and then confirmed by Egger's test.Result1.3 Clinical randomized controlled trials(RCTs),1 clinical non-randomized controlled trials and 11 retrospective cohort study comprising 7493 patients were enrolled in this study.Patients were divided into 3 groups: E group(H.pylori-eradicated group)and P group(H.pylori-persistent group)and N group(H.pylori-negative group).The overall quality of included studies are high,and the evidence grade is from moderate to high level.According to statistical heterogeneity of the studies,a fixed-effect model or a random-effect model was performed to Meta-analysis.2.For patients with EGC after receiving endoscopic treatment,our Meta-analysis showed a significant difference about the occurrence of MGC between E group and P group RR=0.47(95%CI:0.37-0.59,P<0.001,I2=0%),which demonstrated that H.pylori eradication may decrease the incidence of MGC after ER.3.Our Meta-analysis showed a significant difference of incidence of MGC between E group and N group RR=0.48(95%CI:0.28-0.82,P= 0.008,I2=0.0%).It showed that the patients whose H.pylori were eradicated after successful standard treatment have lower incidence of MGC than patients whose H.pylori state were negative.4.Our Meta-analysis indicated that there is no significant difference of incidence of MGC between P group and N group RR=1.19(95%CI:0.30-4.68,P= 0.809,I2=49.8%),which showed patients with H.pylori persistent state may have the same risk of MGC comparing with those without H.pylori infection.Conclusion For patients with EGC after receiving endoscopic treatment,and whose H.pylori test were positive,successful H.pylori eradication may decrease the incidence of metachronous gastric cancer.We strongly recommend to perform it in clinical work.