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Gastric adenocarcinoma in Zambia: A case-control study of HIV, lifestyle risk factors, and biomarkers of pathogenesis

V Kayamba, A W Asombang, V Mudenda, M M Lisulo, E Sinkala, S Mwanamakondo, I Mweemba, P Kelly

Abstract


Background. Gastric cancer is a leading cause of cancer deaths worldwide but there are few data from Africa. We recently observed a trend 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 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).

Authors' affiliations

V Kayamba, Tropical Gastroenterology and Nutrition Project, Department of Medicine, University of Zambia School of Medicine, Lusaka

A W Asombang, Tropical Gastroenterology and Nutrition Project, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Washington University School of Medicine, St Louis, Missouri

V Mudenda, Department of Pathology and Microbiology, University Teaching Hospital, Lusaka

M M Lisulo, Tropical Gastroenterology and Nutrition Project, Department of Medicine, University of Zambia School of Medicine, Lusaka

E Sinkala, Tropical Gastroenterology and Nutrition Project, Department of Medicine, University of Zambia School of Medicine, Lusaka

S Mwanamakondo, Tropical Gastroenterology and Nutrition Project, Department of Medicine, University of Zambia School of Medicine, Lusaka

I Mweemba, Department of Pathology and Microbiology, University Teaching Hospital, Lusaka

P Kelly, Tropical Gastroenterology and Nutrition Project, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London

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Keywords

Cancer, Gastric Adenocarcinoma, Africa, HIV, case-control study

Cite this article

South African Medical Journal 2013;103(4):255-259. DOI:10.7196/SAMJ.6159

Article History

Date submitted: 2012-07-25
Date published: 2013-02-19

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