Helicobacter pylori as a prognostic indicator after curative resection of gastric carcinoma: a prospective study.
BACKGROUND
The effect of Helicobacter-pylori status on survival after curative resection for gastric adenocarcinoma is unknown. We aimed to follow-up patients who were positive or negative for infection with H pylori who had curative (ie, R0) resection for gastric adenocarcinoma to assess differences in relapse-free survival and overall survival.


METHODS
Before surgery, we assessed the H pylori status of 166 patients who had R0 resection for gastric adenocarcinoma between 1992 and 2002 with bacterial culture, histological analyses (ie, staining with haematoxylin and eosin and with Warthin-Starry), and serological analyses.


RESULTS
At a median follow-up of 53.0 months (range 1-146), relapse-free survival was 56.7 months (95% CI 4.7-108.7) and overall survival was 61.9 months (13.0-110.9) in patients positive for H pylori, compared with 19.2 months (12.7-25.6) and 19.2 months (7.1-31.3), respectively, in patients negative for H pylori (p=0.0009 for difference in relapse-free survival between groups, and p=0.0017 for difference in overall survival between groups). In multivariate analyses, H pylori was an independent prognostic factor for relapse-free survival (hazard ratio 2.16 [95% CI 1.33-3.49]) and overall survival (2.00 [1.22-3.27]). Depth of tumour invasion (2.60 [1.66-4.08]), lymph-node metastasis (2.11 [1.25-3.57]), and patient age 67.5 years or older (1.75 [1.11-2.75]) were also independent prognostic factors for overall survival.


CONCLUSIONS
Tumour-specific immune responses might be downregulated in patients who are negative for H pylori, and these patients should be followed up carefully because of a poor outlook.
Meimarakis
Georgios
G
University Hospitals Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany. meimarakis@med.uni-muenchen.de
Winter
Hauke
H
Assmann
Ilka
I
Kopp
Reinhard
R
Lehn
Norbert
N
Kist
Manfred
M
Stolte
Manfred
M
Jauch
Kalter-Walter
KW
Hatz
Rudolf A
RA
D000230:Adenocarcinoma / Q000382:microbiology* / Q000473:pathology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D018572:Disease-Free Survival; D015536:Down-Regulation; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori / Q000302:isolation & purification / Q000472:pathogenicity; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D013274:Stomach Neoplasms / Q000382:microbiology* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome