Gastric cancer prevention by community eradication of Helicobacter pylori: a cluster-randomized controlled trial

被引:5
作者
Pan, Kai-Feng [1 ]
Li, Wen-Qing [1 ]
Zhang, Lian [2 ]
Liu, Wei-Dong [3 ]
Ma, Jun-Ling [2 ]
Zhang, Yang [2 ]
Ulm, Kurt [4 ]
Wang, Jian-Xi [3 ]
Zhang, Lei [2 ]
Bajbouj, Monther [4 ]
Zhang, Lan-Fu [3 ]
Li, Ming [3 ]
Vieth, Michael [5 ]
Quante, Michael [4 ,6 ]
Wang, Le-Hua [3 ]
Suchanek, Stepan [7 ,8 ,9 ]
Mejias-Luque, Raquel [4 ]
Xu, Heng-Min [1 ]
Fan, Xiao-Han [1 ]
Han, Xuan [1 ]
Liu, Zong-Chao [1 ]
Zhou, Tong [2 ]
Guan, Wei-Xiang [2 ]
Schmid, Roland M. [4 ]
Gerhard, Markus [4 ]
Classen, Meinhard [4 ]
You, Wei-Cheng [2 ]
机构
[1] Peking Univ Canc Hosp & Inst, Dept Canc Epidemiol, State Key Lab Holist Integrat Management Gastroint, Beijing Key Lab Carcinogenesis & Translat Res, Beijing, Peoples R China
[2] Peking Univ Canc Hosp & Inst, Dept Canc Epidemiol, Key Lab Carcinogenesis & Translat Res, Minist Educ, Beijing, Peoples R China
[3] Hlth Bur Linqu Cty, Weifang, Peoples R China
[4] Tech Univ Munich, Sch Med & Hlth, Munich, Germany
[5] Friedrich Alexander Univ Erlangen Nuremberg, Inst Pathol, Klinikum Bayreuth, Bayreuth, Germany
[6] Univ Klinikum Freiburg, Freiburg Klin Innere Med 2, Freiburg, Germany
[7] Charles Univ Prague, Fac Med 1, Dept Med, Prague, Czech Republic
[8] Charles Univ Prague, Fac Med 1, Dept Gastrointestinal Oncol, Prague, Czech Republic
[9] Mil Univ Hosp, Prague, Czech Republic
关键词
PRIMARY ANTIBIOTIC-RESISTANCE; HIGH-RISK; POPULATION; LESIONS; INFECTION; REGION; CHINA;
D O I
10.1038/s41591-024-03153-w
中图分类号
Q5 [生物化学]; Q7 [分子生物学];
学科分类号
071010 ; 081704 ;
摘要
Gastric cancer is a leading cause of cancer-related deaths in China. Affecting more than 40% of the world's population, Helicobacter pylori is a major risk factor for gastric cancer. While previous clinical trials indicated that eradication of H. pylori could reduce gastric cancer risk, this remains to be shown using a population-based approach. We conducted a community-based, cluster-randomized, controlled, superiority intervention trial in Linqu County, China, with individuals who tested positive for H. pylori using a C-13-urea breath test randomly assigned to receiving either (1) a 10-day, quadruple anti-H. pylori treatment (comprising 20 mg of omeprazole, 750 mg of tetracycline, 400 mg of metronidazole and 300 mg of bismuth citrate) or (2) symptom alleviation treatment with a single daily dosage of omeprazole and bismuth citrate. H. pylori-negative individuals did not receive any treatment. We examined the incidence of gastric cancer as the primary outcome. A total of 180,284 eligible participants from 980 villages were enrolled over 11.8 years of follow-up, and a total of 1,035 cases of incident gastric cancer were documented. Individuals receiving anti-H. pylori therapy showed a modest reduction in gastric cancer incidence in intention-to-treat analyses (hazard ratio 0.86, 95% confidence interval 0.74-0.99), with a stronger effect observed for those having successful H. pylori eradication (hazard ratio 0.81, 95% confidence interval 0.69-0.96) than for those who failed treatment. Moderate adverse effects were reported in 1,345 participants during the 10-day treatment. We observed no severe intolerable adverse events during either treatment or follow-up. The findings suggest the potential for H. pylori mass screening and eradication as a public health policy for gastric cancer prevention.
引用
收藏
页码:3250 / 3260
页数:11
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