was analyzed using the Kaplan–Meier method, and the difference between the curves of open- and closed-type was tested by Log-rank test. A Cox’s proportional hazards regression model was used to analyze independence of the association Bortezomib clinical trial between the extent of green mucosa in AFI images and development of metachronous EGC. Age, sex, intestinal metaplasia in the lesser curvature of the corpus, serum pepsinogen status, and H. pylori status were selected as candidate covariates for multivariate analysis. P < 0.05 was considered to indicate statistical significance. Eighteen patients in whom AFI endoscopy was not available and who did not undergo AFI observation were excluded, which left a total of 82 patients who were followed up and analyzed. The patients' demographic and clinical characteristics are shown in Table 1. In the AFI images, 31 patients had open-type, chronic atrophic fundic gastritis, and 51 had closed type. PD0325901 manufacturer Among 82 patients who were analyzed, 73 were H. pylori-positive and received eradication therapy, while the remaining nine patients were negative and were not prescribed anti-H. pylori treatment. In 58 of 73 H. pylori-positive patients, the first eradication therapy was successful,
and second-line therapy was successful in five patients. Thus, a total of 72 patients were followed up as an H. pylori negative group. Ten patients who failed first- and second-line eradication therapy were followed up as a persistent H. pylori infection group (Fig. 3). All participants received follow-up endoscopy (median duration of follow-up period, 55 months; range, 14–72 months). Metachronous EGC developed
in nine (12.5%) of 72 patients without H. pylori infection, and in three (30.0%) of 10 patients who had persistent H. pylori infection (Fig. 3). All metachronous EGC detected had a small size (mean tumor size, 6.0 ± 3.6 mm), was confined to the mucosa, Metalloexopeptidase and could be treated by ESD. Pathologically, all EGC was of the differentiated type. The most suitable cut-off points for pepsinogen for metachronous EGC, obtained by receiver operating characteristic curve, were pepsinogen I ≤ 22 ng/mL or pepsinogen I/II ratio ≤ 1.8. Using the most suitable cut-off point for pepsinogen I/II ratio, the sensitivity and specificity for metachronous EGC was 63.6% and 41.0%, respectively. Investigating predictive factors by univariate analysis, age (P = 0.028), intestinal metaplasia in the lesser curvature of the corpus (P = 0.012), and open-type atrophic fundic gastritis diagnosed by AFI (P < 0.001) were significantly associated with the development of metachronous EGC (Table 2). The cumulative 4-year incidence of metachronous EGC was 27.8% in patients with open-type atrophic fundic gastritis diagnosed by AFI and 4.1% in those with closed type, respectively (P < 0.001, Fig. 4).