Abstract：
OBJECTIVE: Helicobacter pylori infection is associated with a decreased risk of esophageal adenocarcinoma, and the decreasing prevalence of such infection might contribute to the increasing incidence of this tumor. We examined the hypothesis that eradication treatment of H pylori increases the risk of esophageal adenocarcinoma.
METHODS: This population-based multinational cohort, entitled \"Nordic Helicobacter Pylori Eradication Project (NordHePEP),\" included all adults (≥18 years) receiving H pylori eradication treatment from 1995-2018 in any of the 5 Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) with follow-up throughout 2019. Data came from national registers. We calculated standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) by dividing the cancer incidence in the exposed cohort by that of the entire Nordic background populations of the corresponding age, sex, calendar period, and country. Analyses were stratified by factors associated with esophageal adenocarcinoma (ie, education, comorbidity, gastroesophageal reflux, and certain medications).
RESULTS: Among 661,987 participants who contributed 5,495,552 person-years after eradication treatment (median follow-up, 7.8 years; range, 1-24 years), 550 cases of esophageal adenocarcinoma developed. The overall SIR of esophageal adenocarcinoma was not increased (SIR = 0.89; 95% CI, 0.82-0.97). The SIR did not increase over time after eradication treatment, but rather decreased and was 0.73 (95% CI, 0.61-0.86) at 11-24 years after treatment. There were no major differences in the stratified analyses. The overall SIR of esophageal squamous cell carcinoma, calculated for comparison, showed no association (SIR = 0.99; 95% CI, 0.89-1.11).
CONCLUSIONS: This absence on an increased risk of esophageal adenocarcinoma after eradication treatment of H pylori suggests eradication is safe from a cancer perspective.
METHODS: This population-based multinational cohort, entitled \"Nordic Helicobacter Pylori Eradication Project (NordHePEP),\" included all adults (≥18 years) receiving H pylori eradication treatment from 1995-2018 in any of the 5 Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) with follow-up throughout 2019. Data came from national registers. We calculated standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) by dividing the cancer incidence in the exposed cohort by that of the entire Nordic background populations of the corresponding age, sex, calendar period, and country. Analyses were stratified by factors associated with esophageal adenocarcinoma (ie, education, comorbidity, gastroesophageal reflux, and certain medications).
RESULTS: Among 661,987 participants who contributed 5,495,552 person-years after eradication treatment (median follow-up, 7.8 years; range, 1-24 years), 550 cases of esophageal adenocarcinoma developed. The overall SIR of esophageal adenocarcinoma was not increased (SIR = 0.89; 95% CI, 0.82-0.97). The SIR did not increase over time after eradication treatment, but rather decreased and was 0.73 (95% CI, 0.61-0.86) at 11-24 years after treatment. There were no major differences in the stratified analyses. The overall SIR of esophageal squamous cell carcinoma, calculated for comparison, showed no association (SIR = 0.99; 95% CI, 0.89-1.11).
CONCLUSIONS: This absence on an increased risk of esophageal adenocarcinoma after eradication treatment of H pylori suggests eradication is safe from a cancer perspective.
摘要：
目的：幽门螺杆菌感染与食管腺癌的风险降低有关，这种感染的患病率下降可能导致这种肿瘤的发病率增加。我们研究了根除幽门螺杆菌治疗增加食管腺癌风险的假设。
方法：这个以人口为基础的跨国队列，题为“北欧幽门螺杆菌根除项目(NordHePEP)，“包括1995-2018年在5个北欧国家中接受幽门螺杆菌根除治疗的所有成年人（≥18岁）（丹麦，芬兰,冰岛,挪威,和瑞典），2019年全年跟进。数据来自国家登记册。我们通过将暴露队列中的癌症发病率除以相应年龄的整个北欧背景人群的癌症发病率，计算了具有95％置信区间（CI）的标准化发病率（SIR）。性别,日历期间,和国家。分析按与食管腺癌相关的因素分层(即，教育,合并症，胃食管反流,和某些药物）。
结果：在根除治疗后贡献5,495,552人年的661,987名参与者中（中位随访，7.8年；范围，1-24岁),550例食管腺癌。食管腺癌的总SIR没有增加（SIR=0.89；95％CI，0.82-0.97）。根除治疗后SIR没有随时间增加，但在治疗后11-24年下降，为0.73（95％CI，0.61-0.86）。在分层分析中没有重大差异。食管鳞癌整体SIR,计算用于比较，未显示相关性（SIR=0.99；95%CI，0.89-1.11）。
结论：根除幽门螺杆菌治疗后食管腺癌风险增加的情况表明，从癌症的角度来看，根除是安全的。
方法：这个以人口为基础的跨国队列，题为“北欧幽门螺杆菌根除项目(NordHePEP)，“包括1995-2018年在5个北欧国家中接受幽门螺杆菌根除治疗的所有成年人（≥18岁）（丹麦，芬兰,冰岛,挪威,和瑞典），2019年全年跟进。数据来自国家登记册。我们通过将暴露队列中的癌症发病率除以相应年龄的整个北欧背景人群的癌症发病率，计算了具有95％置信区间（CI）的标准化发病率（SIR）。性别,日历期间,和国家。分析按与食管腺癌相关的因素分层(即，教育,合并症，胃食管反流,和某些药物）。
结果：在根除治疗后贡献5,495,552人年的661,987名参与者中（中位随访，7.8年；范围，1-24岁),550例食管腺癌。食管腺癌的总SIR没有增加（SIR=0.89；95％CI，0.82-0.97）。根除治疗后SIR没有随时间增加，但在治疗后11-24年下降，为0.73（95％CI，0.61-0.86）。在分层分析中没有重大差异。食管鳞癌整体SIR,计算用于比较，未显示相关性（SIR=0.99；95%CI，0.89-1.11）。
结论：根除幽门螺杆菌治疗后食管腺癌风险增加的情况表明，从癌症的角度来看，根除是安全的。
