2023 Volume 31 Issue 2 Pages 42-52
Objective: To improve the understanding of the etiology of perforated peptic ulcers (PPUs) and their association with cancer development.
Design: Patients with (n = 303) and without (n = 119) PPU underwent human leukocyte antigen (HLA) testing. PPU risk factors, including human endogenous retrovirus-derived peptides, and the incidence and recurrence of PPUs and cancers after acid-suppressive therapy were examined.
Results: Patients with PPUs were younger than those without PPUs and more likely to have duodenal ulcers, consume alcohol, and smoke. Among 422 peptic ulcers, 31 (7.3%) developed cancers 1 year later. Patients with perforations who underwent partial gastrectomy and those who received medication showed a significantly reduced risk of cancer (χ2 test, p < 0.0001, p < 0.0001, and p < 0.0001, respectively). Patients carrying HLA-Cw1 or -Cw7 showed a significantly reduced risk of PPU, except for those carrying HLA-Cw1 in the peptide K group (χ2 test, p = 0.016). Patients carrying HLA-Cw3 in subgroup Hc showed a significantly reduced risk of cancer development. The HLA-Cw1 and -Cw1 heterotypes of peptide subgroup Ad showed a significantly reduced risk of recurrence (log-rank test, p = 0.007 and p = 0.02, respectively), whereas the HLA-Cw7 heterotypes of peptide subgroups Aa–Ac and group C showed a significantly increased risk of recurrence (log-rank test, p = 0.036 and p = 0.047, respectively), with the exception of patients in peptide group B (log-rank test, p = 0.012).
Conclusion: HLA-Cw1 and -Cw7 and their heterozygotes protected against PPU development, whereas HLA-Cw3 reduced cancer development.
