Open AccessHelicobacter pylori infection‐negative gastric cancer in Japanese hospital patients: Incidence and pathological characteristics
Author(s) -
Kato Shunji,
Matsukura Norio,
Tsukada Katsuya,
Matsuda Noriko,
Mizoshita Tsutomu,
Tsukamoto Tetsuya,
Tatematsu Masae,
Sugisaki Yuichi,
Naito Zenya,
Tajiri Takashi
Publication year - 2007
Publication title -
cancer science
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.035
H-Index - 141
eISSN - 1349-7006
pISSN - 1347-9032
DOI - 10.1111/j.1349-7006.2007.00478.x
Subject(s) - helicobacter pylori , gastroenterology , cancer , atrophy , medicine , pepsin , intestinal metaplasia , atrophic gastritis , gastric mucosa , antibody , stomach , pathology , gastritis , population , immunology , biology , biochemistry , environmental health , enzyme
We used Helicobacter pylori sero‐positivity and mucosal atrophy as detected by the serum pepsinogen method to identify H. pylori infection‐negative gastric cancer patients with or without atrophy. One hundred and six of 748 (14.2%) primary gastric cancer patients were infection‐negative by a serum antibody detection system. Further, 121 (16.2%) of the 748 were negative for gastric mucosal atrophy by the pepsinogen method, of whom 15/748 (2.0%) were H. pylori ‐negative by pepsinogen I level (>70 ng/mL) and pepsinogen I/II ratio (>3.0). Twenty‐seven of 782 (3.6%) gastric cancer patients were H. pylori ‐negative by antibodies and severe atrophy as determined by pepsinogen I level (<30 ng/mL) and pepsinogen I/II ratio (<2.0). H. pylori ‐negative gastric cancer patients with severe atrophy likely had a previous infection. These results indicate that the actual number of H. pylori ‐negative patients is 2.0% at minimum and 10.6% (14.2% minus 3.6%) at maximum in the general Japanese population. Five of 15 (33%) cases displaying neither anti‐ H. pylori antibodies nor atrophy were intestinal‐type and 10 (67%) were diffuse‐type adenocarcinomas. Thirteen surgical patients with primary gastric cancer displaying neither antibodies nor mucosal atrophy were further analyzed for pathological and phenotypic characteristics. The mucin phenotype was divided into four gastric, five gastric and intestinal, two intestinal and two null types, independent of histological classification. Intestinal phenotype elements were detected by Cdx2 immunohistochemical methods in nine of 13 (70%) cases examined. We conclude that a small fraction of gastric cancer patients displayed multifactorial carcinogenesis without H. pylori infection, indicating that gastric cancer risk still exists in the absence of H. pylori infection, at an incidence of 2.0% at minimum and 10.6% at maximum in the general Japanese population. ( Cancer Sci 2007; 98: 790–794)