It is important to evaluate the risk for the secondary cancer developments after the treatment of stomach cancer patients in the residual or whole stomach with gastrectmy or endoscopic mucosal dissection (ESD). Recent advanced less invasive treatments for stomach cancer resulted to occur secondary cancers in the residual stomach in recent decade. Persistence of H. pylori infection, the refluxes of the bile and pancreas juices to the stomach, neutralization of the pH levels to reproduce the nitroso-carcinogenic compounds are important for the stomach carcinogenesis, but there are no clinical guidelines for the endoscopic observation procedures for early detection of the secondary cancer. In this study, to know the morbidity late of the secondary stomach cancer, a cumulate regenerating cancer rate was calculated for the patients with 184 gastrectomy patients or 38 patients with local controls by ESD and the pathological characteristic of the residual stomach mucosa were revealed to know the relative risk for the cancer developments. There were 7 patients after gastrectomy and 5 patients after local gastrectomy or ESD treatments with secondary stomach cancers during 7.8 years and 5 years interval after the treatments by 6.1 years and 3 years-endoscopic observations, respectively. The cumulate regenerating morbidity was higher in the post-ESD (5/35; 14.3%) patients, Billroth II re-construction (3/40; 7.5%), and Billroth I re-construction procedure (2/107; 1.9%), with or without the persistence of H.pylori infection. The background of the stomach mucosa evaluated by updated Sydney System Scores revealed the possibilities of predictions for the secondary stomach cancer developments by the degree of inflammation score evaluated from lymphocyte migration in the stomach mucosa, which relative risk for secondary cancer was 4.1(95% C.I.: 2.4 - 7.1) with moderate or severe in the upper part of angles in lesser curvature without H.pylori infection after the eradication therapy or naturally elimination of H.pylori by bile reflux in the mucosa comparing with the none or slight inflammation scores. These results indicated the patients without improvements of inflammations after the eradication of H.pylori, showed the higher risk for newly carcinogenesis in the stomach. The inflammation score after H.pylori eradication will be good biomarkers to predict not only for the risk assessments of secondary gastric carcinogenesis, but also for clinical benefits to decide the time intervals for endoscopic observations as a screening after gastrectomy patients.
99th AACR Annual Meeting-- Apr 12-16, 2008; San Diego, CA