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Preoperative Helicobacter pylori Infection is Associated with Increased Survival After Resection of Gastric Adenocarcinoma

Annals of Surgical Oncology volume 23, pages 1225–1233 (2016)Cite this article

Abstract

Background

Limited data exist on the prognosis of preoperative Helicobacter pylori (H. pylori) infection in gastric adenocarcinoma (GAC).

Methods

Patients who underwent curative-intent resection for GAC from 2000 to 2012 at seven academic institutions comprising the United States Gastric Cancer Collaborative were included in the study. The primary end points of the study were overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS).

Results

Of 559 patients, 104 (18.6 %) who tested positive for H. pylori were younger (62.1 vs 65.1 years; p = 0.041), had a higher frequency of distal tumors (82.7 vs 71.9 %; p = 0.033), and had higher rates of adjuvant radiation therapy (47.0 vs 34.9 %; p = 0.032). There were no differences in American Society of Anesthesiology (ASA) class, margin status, grade, perineural invasion, lymphovascular invasion, nodal metastases, or tumor-node-metastasis (TNM) stage. H. pylori positivity was associated with longer OS (84.3 vs 44.2 months; p = 0.008) for all patients. This relationship with OS persisted in the multivariable analysis (HR 0.54; 95 % CI 0.30–0.99; p = 0.046). H. pylori was not associated with RFS or DSS in all patients. In the stage 3 patients, H. pylori was associated with longer OS (44.5 vs 24.7 months; p = 0.018), a trend of longer RFS (31.4 vs 21.6 months; p = 0.232), and longer DSS (44.8 vs 27.2 months; p = 0.034).

Conclusions

Patients with and without preoperative H. pylori infection had few differences in adverse pathologic features at the time of gastric adenocarcinoma resection. Despite similar disease presentations, preoperative H. pylori infection was independently associated with improved OS. Further studies examining the interaction between H. pylori and tumor immunology and genetics are merited.

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Acknowledgment

This study was supported in part by the Katz Foundation.

Disclosures

None.

Author information

Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Lauren M. Postlewait MD, Malcolm H. Squires III MD, MS, David A. Kooby MD, Kenneth Cardona MD, Charles A. Staley MD & Shishir K. Maithel MD

  2. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    George A. Poultsides MD & David J. Worhunsky MD

  3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber MD, Alexandra W. Acher BS, Clifford S. Cho MD & Emily R. Winslow MD

  4. Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Mark Bloomston MD, Carl R. Schmidt MD & Neil Saunders MD

  5. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Ryan C. Fields MD & Linda X. Jin MD

  6. Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA

    Timothy M. Pawlik MD, MPH, PhD & Aslam Ejaz MD

  7. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Konstantinos I. Votanopoulos MD & Douglas Swords MD

Authors
  1. Lauren M. Postlewait MD
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  2. Malcolm H. Squires III MD, MS
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  3. David A. Kooby MD
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  4. George A. Poultsides MD
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  5. Sharon M. Weber MD
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  6. Mark Bloomston MD
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  7. Ryan C. Fields MD
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  9. Konstantinos I. Votanopoulos MD
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  11. Aslam Ejaz MD
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  12. Alexandra W. Acher BS
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  13. David J. Worhunsky MD
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  14. Neil Saunders MD
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  15. Douglas Swords MD
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  16. Linda X. Jin MD
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  17. Clifford S. Cho MD
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  18. Emily R. Winslow MD
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  19. Kenneth Cardona MD
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  20. Charles A. Staley MD
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  21. Shishir K. Maithel MD
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Corresponding author

Correspondence to Shishir K. Maithel MD.

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Postlewait, L.M., Squires, M.H., Kooby, D.A. et al. Preoperative Helicobacter pylori Infection is Associated with Increased Survival After Resection of Gastric Adenocarcinoma. Ann Surg Oncol 23, 1225–1233 (2016). https://doi.org/10.1245/s10434-015-4953-x

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  • DOI: https://doi.org/10.1245/s10434-015-4953-x

Keywords

  • Overall Survival
  • Pylorus Infection
  • Gastric Adenocarcinoma
  • Longe Overall Survival
  • Pylorus Status