Abstract
BackgroundPrevious researches have associated Helicobacter pylori (H. pylori) with a prognosis of gastric cancer (GC), however, without a concert conclusion. This study aimed to study this issue further by a prospective cohort study and a meta-analysis.MethodsHistologically diagnosed gastric cancer (GC) patients were recruited into the primary prospective cohort study between January 2009 to December 2013. All the patients were followed-up periodically to record information on post-surgery therapy and overall survival status. The pre-surgery status of H. pylori was measured by enzyme-linked immunosorbent assay. A meta-analysis was conducted after retrieving related researches in the databases of PubMed and Embase up to April 2020. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were summarized to validate the relationship between H. pylori infection and the survival time of GC patients. I2 statistics and Q test were used to assess the heterogeneity. Sensitivity analyses were performed using Galbraith’s plot, leave-one-out analysis, subgroup analyses and meta-regression to explore the sources of heterogeneity and the stability of the summary results.ResultsA total of 743 GC patients with radical tumorectomy were included prospectively and 516 (69.4%) were positive on H. pylori. H. pylori-positive patients tended to survive longer than -negative ones (HR 0.92, 95%CI: 0.74–1.15), though the tendency was not statistically significant. Cohort studies on the prognosis of GC were retrieved comprehensively by assessing the full-text and 59 published studies, together with the result of our study, were included in the further meta-analysis. The summarized results related the positive status of H. pylori to better overall survival (HR 0.81, 95%CI: 0.72–0.90) and disease-free survival (HR 0.83, 95%CI: 0.67–0.99). Results from subgroup analyses indicated that the pooled magnitude of this association was relatively lower in studies not referring to H. pylori in title and abstract.ConclusionsIn conclusion, gastric cancer patients with H. pylori have a better prognosis than patients of H. pylori negative. More stringent surveillance strategies may be necessary for patients with H. pylori negative at cancer diagnosis.
Highlights
Previous researches have associated Helicobacter pylori (H. pylori) with a prognosis of gastric cancer (GC), without a concert conclusion
Extensive studies have concluded that H. pylori infection contributed to gastric cancer, and it is estimated that nearly two-thirds of new gastric cancer cases are attributable to chronic H. pylori infection [3] and the eradication of H. pylori could reduce the risk of GC [4]
H. pylori infection can result in chronic gastritis, which can progress to gastric atrophy, intestinal metaplasia, and dysplasia, and subsequently to gastric cancer
Summary
Previous researches have associated Helicobacter pylori (H. pylori) with a prognosis of gastric cancer (GC), without a concert conclusion. In 2018, it was estimated that over 782, 000 patients died of gastric cancer, and more than half of the deaths occurred in Eastern Asia [1]. More studies were warranted to recognize patients at risk of recurrence or death from GC by exploring more biomarkers. Helicobacter pylori (H. pylori), a bacterium colonizing in the stomach, was graded as a Group I carcinogen in 1994 by the International Agency for Research on Cancer [2]. Extensive studies have concluded that H. pylori infection contributed to gastric cancer, and it is estimated that nearly two-thirds of new gastric cancer cases are attributable to chronic H. pylori infection [3] and the eradication of H. pylori could reduce the risk of GC [4]
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