Negative Helicobacter pylori status is associated with poor prognosis in patients with gastric cancer.
BACKGROUND
Recent studies have suggested that Helicobacter pylori (H. pylori) infection may be related to better prognosis in patients with gastric cancer, but to the authors' knowledge, this finding has not yet been validated. In the current study, the association between H. pylori status and clinical outcome was investigated in a large cohort of patients.


METHODS
Frozen non-neoplastic gastric mucosa and serum samples obtained from 297 patients who underwent surgery for primary gastric cancer between 1988 and 2004 were retrieved from the serum and tissue bank of the study department. H. pylori status was defined by means of polymerase chain reaction (PCR) analysis for the vacA gene in gastric mucosa and by serologic assay of H. pylori and CagA antibodies. Univariate and multivariate analyses were used for the association between clinicopathologic variables and long-term outcome.


RESULTS
Positivity for H. pylori infection was observed in 256 of 297 patients (86%), whereas in 41 patients (14%), PCR for vacA and both serologic tests were negative. Negative H. pylori status was found to be significantly associated with cardia location, advanced pT classification, noncurative surgery, and a lower 5-year survival rate after R0 resection (24% vs 57%; P < .001). Multivariate survival analysis confirmed H. pylori status as a significant prognostic factor (hazards ratio, 2.47; 95% confidence interval, 1.40-4.35 [P = .002]). The influence of H. pylori status on long-term survival was observed in patients with early as well as advanced pT classifications.


CONCLUSIONS
Negative H. pylori status appears to be an indicator of poor prognosis in patients with gastric cancer, and is independent of other well-known clinical and pathologic prognostic variables.
Marrelli
Daniele
D
Department of Human Pathology and Oncology, University of Siena, Siena, Italy. marrelli@unisi.it
Pedrazzani
Corrado
C
Berardi
Anna
A
Corso
Giovanni
G
Neri
Alessandro
A
Garosi
Lorenzo
L
Vindigni
Carla
C
Santucci
Annalisa
A
Figura
Natale
N
Roviello
Franco
F
D000368:Aged; D000942:Antigens, Bacterial / Q000097:blood; D001426:Bacterial Proteins / Q000097:blood / Q000235:genetics; D005260:Female; D005798:Genes, Bacterial; D016481:Helicobacter Infections / Q000150:complications* / Q000175:diagnosis; D016480:Helicobacter pylori / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000150:complications* / Q000382:microbiology* / Q000401:mortality; D013997:Time Factors
D000942:Antigens, Bacterial; D001426:Bacterial Proteins; C074689:VacA protein, Helicobacter pylori; C080866:cagA protein, Helicobacter pylori