University of Kansas School of Medicine Wichita, KS
Award: Presidential Poster Award
Katia El Jurdi, MD1, Sachin Srinivasan, MD1, Yasmine Hussein Agha, MD2, Ali Taleb, MD1, Chelsea Wuthnow, MD1, Saritha Gorantla, MD1, William R. Kilgore, MD1, Nathan Tofteland, MD1, William J. Salyers, MD1; 1University of Kansas School of Medicine, Wichita, KS; 2University of Kansas, School of Medicine, Wichita, KS
Introduction: Esophageal cancer (EsoCa) is the 9th most common cancer and the 6th most common cause of cancer deaths worldwide. Helicobacter pylori (H. pylori) has been shown to play a role in gastric cancer, but its relationship to EsoCa remains controversial. The aim of this meta-analysis is to determine whether an association exists between H. pylori and the subsequent development of EsoCa. Methods: We performed an electronic search of PubMed, Embase, Web of Science, and Cochrane databases for studies that reported data on EsoCa occurrences and H. pylori status from inception to April 1, 2020. Case reports/series, editorials and review articles were excluded. Primary outcomes included pooled weighted incidence of EsoCa in H. pylori positive (HP+) and negative (HP-) groups and the pooled odds of cancer occurrence in HP+ compared to HP- groups. We also performed subgroup analysis for studies by geographical location (Western vs. Asian studies) and meta-regression for the primary outcome based on age and duration of follow-up. Meta-analysis outcomes, heterogeneity (I2), meta-regression (for effect of covariates) and publication bias (Rucker’s test) were derived by statistical software R and Open meta-analyst. Results: Our initial search resulted in 1,624 articles, all of which were screened by two independent reviewers. A total of 23 studies with 39,932 patients [mean age 58 ± 4.9 years, mean follow-up duration of 75 months (range 12-216 months)] were included for analysis. Pooled incidence of EsoCa in the HP+ group was 9.8% (95%CI 8.8-10.9) and in the HP- group was 22% (95%CI 20.1-24.0). Odds of EsoCa was significantly lower in the HP+ group compared to that of the HP-group (OR 0.69; 95%CI 0.58-0.82; I2=79%). Subgroup analysis with 17 Western studies (OR 0.68; 95%CI 0.55-0.85; I2=78%) and 6 Asian studies (OR 0.71; 95%CI 0.50-1.00; I2=84%) showed that the odds of EsoCa was consistently lower in the HP+ group compared to the HP- group. Meta-regression did not demonstrate any significance of age (p=0.11) or duration of follow-up (0.44) to the incidence of EsoCa. There was no significant publication bias (Rucker’s coefficient for funnel plot asymmetry=0.07). Discussion: The presence of H. pylori appears to exert a protective effect against the development of EsoCa. This may have implications on decisions to treat in certain high-risk populations. Randomized controlled trials are needed to better characterize the effects of H. pylori and the potential consequences of its eradication on EsoCa development.
Figure 1. Forest plot of H. pylori and risk of esophageal cancer.
Figure 2. Meta-regression analysis of age to incidence of esophageal cancer.
Figure 3. Meta-regression analysis of study duration to the incidence of esophageal cancer.
Disclosures: Katia El Jurdi indicated no relevant financial relationships. Sachin Srinivasan indicated no relevant financial relationships. Yasmine Hussein Agha indicated no relevant financial relationships. Ali Taleb indicated no relevant financial relationships. Chelsea Wuthnow indicated no relevant financial relationships. Saritha Gorantla indicated no relevant financial relationships. William Kilgore indicated no relevant financial relationships. Nathan Tofteland indicated no relevant financial relationships. William Salyers indicated no relevant financial relationships.