Prevalence of Helicobacter pylori Positive Non-cardia Gastric Adenocarcinoma Is Low and Decreasing in a US Population
Helicobacter pylori infection is an established causal factor for non-cardia gastric cancer. H. pylori negative gastric cancer prevalence among US patients is unclear.
This retrospective cohort study examined H. pylori prevalence among consecutive patients with incident non-cardia gastric adenocarcinoma at the Houston VA Hospital (11/2007–10/2018). H. pylori positivity was defined by H. pylori on histopathology, positive antibody serology, stool antigen, or urea breath testing. We examined for trends in H. pylori negative gastric cancer based on year of diagnosis. Associations between histopathologic and cancer-related outcomes with H. pylori positivity were determined using regression models.
Of 91 patients with gastric adenocarcinoma, most were men (N = 87, 95.6%), black (N = 47, 51.6%), with mean age at diagnosis of 68.0 years (SD 10.8). In addition to gastric cancer biopsy histopathology, 74 patients (81.3%) had ≥ 1 testing for H. pylori, including antibody serology (n = 34), non-cancer gastric biopsy histopathology (n = 63), or stool antigen (n = 1). The overall prevalence of H. pylori infection was 38.5% and 45.9% among patients with ≥ 2 H. pylori tests. The proportions of H. pylori positive gastric cancer decreased from 50.0% (2007–2010) to 43.4% (2011–2014) and 29.3% (2015–2018) (p = 0.096). Active/acute gastritis (adjOR 3.74), atrophic gastritis (adjOR 15.30), and gastric intestinal metaplasia (adjOR 3.65) were associated with H. pylori positive gastric cancer.
The prevalence of H. pylori infection among patients with non-cardia gastric adenocarcinoma is relatively low (38.5–45.9%) and decreasing over time. This finding suggests there may be other important causal factors apart from H. pylori for gastric adenocarcinoma.
KeywordsEpidemiology Gastric cancer Gastric adenocarcinoma Helicobacter pylori Veterans affairs Prevalence
(i) Mimi C. Tan, MD, MPH is guarantor of the article; (ii) Specific author contributions: THN collected and analyzed the data, designed the research study, wrote the paper, and contributed to the design of the study; NM and TH collected the data and contributed to the design of the study; YL analyzed the data and contributed to the design of the study; APT, HBE, MCT analyzed the data, designed the research study, wrote the paper, and contributed to the design of the study; (iii) All authors have approved the final version of the manuscript.
This work was supported in part by National Institutes of Health Grant P30 DK056338 (Study Design and Clinical Research Core), which supports the Texas Medical Center Digestive Diseases Center. This research was supported in part with resources at the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), at the Michael E. DeBakey VA Medical Center, Houston, TX. The opinions expressed reflect those of the authors and not necessarily those of the Department of Veterans Affairs, the US government or Baylor College of Medicine.
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Conflicts of interest
The authors report no competing interests for this publication.
- 1.Ferlay J, Soerjomataram I, Ervik M. Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. International Agency for Research on Cancer. Published 2013. Accessed January 2019.Google Scholar
- 2.Cancer IAfRo. Estimated age-standardized incidence rates in 2018, worldwide, both sexes, all ages. In: Globocan. International Agency for Research on Cancer; 2018.Google Scholar
- 3.IARC Helicobacter pylori Working Group. Helicobacter pylori Eradication as a Strategy for Gastric Cancer Prevention 2014; No. January, Lyon, France.Google Scholar
- 9.Eom BW, Jung KW, Won YJ, Yang H, Kim YW. Trends in gastric cancer incidence according to the clinicopathological characteristics in Korea, 1999–2014. Cancer Res Treat Off J Korean Cancer Assoc. 2018;50:1343–1350.Google Scholar