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Apr 30, 2013Article Details
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Main Article Content
Gastric adenocarcinoma in Zambia: A case-control study of HIV, lifestyle risk factors, and biomarkers of pathogenesis
Abstract
towards diagnosis in younger patients.
Objective. To test the hypothesis that HIV might have altered risk factors for acquisition of gastric cancer, in a case-control study in the
University Teaching Hospital, Lusaka, Zambia.
Methods. Patients (n=52) with confirmed gastric adenocarcinoma and controls (n=94) undergoing endoscopy but with no macroscopic
gastric pathology. Established risk factors and HIV status were compared.
Results. HIV status did not differ significantly between cases and controls (odds ratio 1.03; 95% CI 0.2 - 4.3; p=1.00) and seroprevalence
in cases was similar to that of the Zambian population. Smoking, regular alcohol intake, and gastric atrophy were all associated with cancer
in univariate and multivariate analysis. Helicobacter pylori serology was positive in 84% of patients studied and cytotoxin-associated gene A
(cagA) serology in 66%; neither serological marker was associated with cancer. Atrophy was common in cases (57%) and controls (30%) and
associated with both smoking and alcohol use. Intestinal metaplasia was present in 17% of the controls, but was not associated with atrophy.
Conclusions. HIV was not associated with gastric cancer and does not explain the apparent younger age distribution. Atrophy was common
and was not essential for the development of intestinal metaplasia, suggesting that gastric carcinogenesis in Africa does not always follow
the pathway from atrophy to intestinal metaplasia to gastric carcinoma (the so-called Correa pathway).
