title: Effect of Helicobacter pylori Eradication on Long-Term Survival after Distal Gastrectomy for Gastric Cancer.
abstract: OBJECTIVE
  Negative Helicobacter pylori status has been identified as a poor prognostic factor for survival in gastric cancer (GC) patients who underwent surgery. The aim of this study was to examine the effect of H. pylori eradication on long-term outcomes after distal gastrectomy for GC.
  
  
  METHODS
  We analyzed the survival of 169 distal GC patients enrolled in a prospective randomized trial evaluating histologic changes of gastric mucosa after H. pylori eradication in the remnant stomach. The outcomes measured were overall survival (OS) and GC recurrence rates.
  
  
  RESULTS
  The median follow-up duration was 9.4 years. In the modified intention-to-treat analysis including patients who underwent H. pylori treatment (n=87) or placebo (n=82), 5-year OS rates were 98.9% in the treatment group and 91.5% in the placebo group, and Kaplan-Meier analysis showed no significant difference in OS (p=0.957) between groups. In multivariate analysis, no difference in overall mortality was observed between groups (adjusted hazard ratio [aHR] for H. pylori treatment, 0.75; p=0.495) or H. pylori-eradicated status (aHR for positive H. pylori status, 1.16; p=0.715), while old age, male sex, and advanced stage ≥ IIIa were independent risk factors. Six patients in the treatment group (6.9%) and seven patients in the placebo group (8.5%) had GC recurrences, and GC recurrence rates were not different according to H. pylori treatment (5-year GC recurrence rates, 4.6% in the treatment group vs. 8.5% in the placebo group; p=0.652).
  
  
  CONCLUSIONS
  H. pylori eradication for GC patients who underwent distal gastrectomy did not compromise long-term survival after surgery.
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Korea.
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Kim
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Korea.
authors.forename: Soo-Jeong
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Korea.
authors.forename: Jong Yeul
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Korea.
authors.forename: Chan Gyoo
authors.initials: CG
authors.lastname: Kim
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Korea.
authors.forename: Myeong-Cherl
authors.initials: MC
authors.lastname: Kook
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Korea.
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Korea.
authors.forename: Young-Woo
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Korea.
authors.forename: Il Ju
authors.initials: IJ
authors.lastname: Choi
mesh_terms: D000230:Adenocarcinoma / Q000382:microbiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017322:Clinical Trials, Phase II as Topic; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D005753:Gastric Mucosa / Q000187:drug effects / Q000382:microbiology*; D018530:Gastric Stump / Q000473:pathology*; D005763:Gastroenterostomy / Q000009:adverse effects / Q000379:methods; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000382:microbiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
keywords: Gastrectomy; Helicobacter pylori; Stomach Neoplasms; Survival