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Long-term risk of gastric cancer by subsite in operated and unoperated patients hospitalized for peptic ulcer

Bahmanyar, S. and Ye, W. and Dickman, P.W. and Nyrén, O. (2007) Long-term risk of gastric cancer by subsite in operated and unoperated patients hospitalized for peptic ulcer. American Journal of Gastroenterology, 102 (6). pp. 1185-1191. ISSN 00029270 (ISSN)

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Abstract

OBJECTIVE: We aimed to investigate whether the elevated risk of gastric cancer among patients with gastric ulcer (GU) and the enigmatic low risk among patients with duodenal ulcer (DU) pertain to both cardia and noncardia cancer. We also studied the risks among operated patients while taking the disparate baseline risks into consideration. METHODS: Retrospective cohorts of 59,550 and 79,412 unoperated patients with DU and GU, respectively, plus 12,840 patients with partial gastric resection and 8,105 with vagotomy, recorded in the Swedish Inpatient Register since 1970, were followed from the first hospitalization (date of operation for the surgery cohort) until occurrence of any cancer, death, emigration, definitive surgery, or December 31, 2003. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) expressed relative risk (RR), compared to the age-, sex-, and calendar period-matched Swedish population. Cox regression produced adjusted RR estimates among operated patients, relative to unoperated ones with the same ulcer type. RESULTS: While unoperated DU patients had a halved risk of noncardia cancer (SIR = 0.5, 95% CI 0.4-0.7), their risk of cardia cancer was slightly above expectation (SIR = 1.2, 95% CI 0.8-1.7). Unoperated GU patients had doubled risks for both cancers (SIR = 2.1, 95% CI 2.0-2.4 and SIR = 1.9, 95% CI 1.4-2.3, respectively). DU patients who underwent gastric resection had a 60% risk elevation (RR = 1.6, 95% CI 1.0-2.5) compared to unoperated ones. Vagotomy was associated with a greater risk in the first 10 yr, but this excess disappeared with further follow-up. Resected GU patients had a 40% risk reduction relative to their unoperated peers (RR = 0.6, 95% CI 0.5-0.8). This reduction persisted well beyond the first postoperative decade. CONCLUSION: The DU-related protection against gastric cancer does not seem to pertain to cardia cancer. With gastric resection, risks are shifted toward normality, regardless of underlying ulcer type. © 2007 by Am. Coll. of Gastroenterology.

Item Type: Article
Additional Information: Unmapped bibliographic data: LA - English [Field not mapped to EPrints] J2 - Am. J. Gastroenterol. [Field not mapped to EPrints] C2 - 17355418 [Field not mapped to EPrints] AD - Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden [Field not mapped to EPrints] AD - Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran [Field not mapped to EPrints] AD - Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE 171 77, Stockholm, Sweden [Field not mapped to EPrints] DB - Scopus [Field not mapped to EPrints]
Uncontrolled Keywords: adult, age distribution, aged, article, cancer mortality, cancer risk, cancer surgery, cardia, confidence interval, controlled study, duodenum ulcer, female, follow up, gastrectomy, gastrectomy Billroth I, gastrectomy Billroth II, hospital patient, hospitalization, human, major clinical study, male, peptic ulcer, priority journal, proportional hazards model, risk reduction, sex ratio, stomach cancer, stomach ulcer, Sweden, vagotomy, Adult, Aged, Aged, 80 and over, Cardia, Duodenal Ulcer, Female, Follow-Up Studies, Gastrectomy, Humans, Male, Middle Aged, Peptic Ulcer, Retrospective Studies, Stomach Neoplasms, Stomach Ulcer, Vagotomy
Subjects: مقالات نمایه شده محققین دانشگاه در سایت ,Web of Science ,Scopus
Divisions: معاونت تحقیقات و فناوری
Depositing User: GOUMS
Date Deposited: 15 Apr 2015 08:50
Last Modified: 15 Feb 2017 05:25
URI: http://eprints.goums.ac.ir/id/eprint/2389

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