Helicobacter pylori Infection and Metachronous Gastric Cancer in Elderly Patients With Gastric Cancer Aged ≥ 75 Years Who Underwent Endoscopic Submucosal Dissection.

[BACKGROUND AND AIMS] Helicobacter pylori (Hp) infection is associated with metachronous gastric cancer (GC) after endoscopic submucosal dissection resection (ESD) in patients with early GC (EGC), but this association has not been well investigated in elderly patients. This study investigated whether Hp infection status was associated with metachronous GC after ESD in patients aged ≥ 75 years.

[METHODS] This retrospective study involved 298 EGC patients aged ≥ 75 years who underwent ESD. The Hp-negative group (n = 233) included patients with negative or eradicated Hp infection, whereas the Hp-positive group (n = 65) included patients with persistently positive infection or failed eradication. The primary outcome was metachronous GC occurring at ≥ 1 year after ESD.

[RESULTS] The median patient age was 78 years (interquartile range [IQR]: 76-80 years). During a median follow-up of 4.4 years (IQR: 2.9-5.9 years), metachronous GC occurred in 16 (6.9% [16/233], 16.3 cases/1000 person-year) and 10 (15.4% [10/65], 37.5 cases/1000 person-year) patients in the Hp-negative and Hp-positive groups, respectively. The incidence of metachronous cancer was higher in the Hp-positive group than in the Hp-negative group (p = 0.035, log-rank test). In a multivariate analysis, persistent Hp infection was an independent risk factor for metachronous GC (age- and sex-adjusted hazard ratio, 2.33; 95% CI: 1.05-5.17).

[CONCLUSIONS] Persistent H. pylori infection status was associated with a higher risk of metachronous GC, and H. pylori treatment needs to be provided in elderly patients aged ≥ 75 years and older with EGC undergoing ESD.