title: Helicobacter pylori infection as an independent prognostic factor for locally advanced gastric cancer patients treated with adjuvant chemotherapy after curative resection.
abstract: A few studies reported the association between negative Helicobacter pylori infection and poor clinical outcome in resected gastric cancer patients. We investigated the H. pylori infection status and its association with the clinical outcome in 274 locally advanced gastric cancer patients (American Joint Committee on Cancer stage IB: 25, II: 82, IIIA: 80, IIIB: 39 and IV: 48) who underwent adjuvant chemotherapy after curative resection (≥ D2 dissection). H. pylori infection status in hematoxylin and eosin stained corporal and antral mucosa of non-tumor tissue was graded according to the updated Sydney System and categorized as H. pylori negative (normal or mild infection) and H. pylori positive (moderate or marked infection). Eighty-one patients received 5-fluorouracil (5-FU) and doxorubicin-based chemotherapy, while 193 patients underwent 5-FU, mitomycin-C and polysaccharide-K chemotherapy. The median follow-up duration of survivors was 144 (120-184) months. In univariate analysis, patients with H. pylori negative status (108 patients) demonstrated significantly poor 10-year overall survival (OS) compared to those with H. pylori-positive status (166 patients; 21.3% vs. 71.1%, p < 0.0001). H. pylori negative status was associated with poor outcome in all stages except stage IIIB. In multivariate analysis, H. pylori-negative status was the most significant independent prognostic factor of poor OS (hazard ratio: 3.45, 95% confidence interval: 2.43-4.89, p < 0.0001) followed by old age (>54 years, p < 0.0001), advanced stage (stage III or IV, p = 0.001), and Borrmann type IV (p = 0.027). H. pylori infection status seems to have strong prognostic significance in locally advanced gastric cancer. H. pylori-negative patients may need careful follow-up after curative resection.
authors.affiliation: Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Seok Yun
authors.initials: SY
authors.lastname: Kang
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Mi Sun
authors.initials: MS
authors.lastname: Ahn
authors.forename: Hyun Woo
authors.initials: HW
authors.lastname: Lee
authors.forename: Seong Hyun
authors.initials: SH
authors.lastname: Jeong
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Park
authors.forename: Yong Kwan
authors.initials: YK
authors.lastname: Cho
authors.forename: Sang-Uk
authors.initials: SU
authors.lastname: Han
authors.forename: Young Bae
authors.initials: YB
authors.lastname: Kim
authors.forename: Jang Hee
authors.initials: JH
authors.lastname: Kim
authors.forename: Seung Soo
authors.initials: SS
authors.lastname: Sheen
authors.forename: Ho-Yeong
authors.initials: HY
authors.lastname: Lim
authors.forename: Jin-Hyuk
authors.initials: JH
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005743:Gastrectomy; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality / Q000628:therapy*