Distinct Clinicopathological Features and Prognosis of Helicobacter pylori Negative Gastric Cancer.
BACKGROUND
Whether the characteristics and prognosis of gastric cancer (GC) are different in patients with and without Helicobacter pylori (HP) remains controversial. The definitions of HP status in patients with atrophic gastritis but negative tests for HP are heterogeneous. We aimed to assess the impact of HP on the prognosis of GC using different definitions.


METHODS
From 1998 Nov to 2011 Jul, five hundred and sixty-seven consecutive patients with GC were included. HP status was determined by serology and histology. Patients with any positive test were defined as HP infection. Patients without HP infection whose serum pepsinogen (PG) I <70 ng/dl and PG I/II ratio < 3.0 were defined as atrophic gastritis and they were categorized into model 1: HP positive; model 2: HP negative; and model 3: exclusion of these patients.


RESULTS
We found four characteristics of HP negative GC in comparison to HP positive GC: (1) higher proportion of the proximal tumor location (24.0%, P = 0.004), (2) more diffuse histologic type (56.1%, p = 0.008), (3) younger disease onset (58.02 years, p = 0.008) and (4) more stage IV disease (40.6%, p = 0.03). Patients with negative HP had worse overall survival (24.0% vs. 35.8%, p = 0.035). In Cox regression models, the negative HP status is an independent poor prognostic factor (HR: 1.34, CI:1.04-1.71, p = 0.019) in model 1, especially in stage I, II and III patients (HR: 1.62; CI:1.05-2.51,p = 0.026).


CONCLUSIONS
We found the distinct characteristics of HP negative GC. The prognosis of HP negative GC was poor.
Department of Internal Medicine, Gastroenterology and Hepatology Section, An Nan Hospital, China Medical University, Tainan, Taiwan.|Department of Internal Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Kun-Feng
KF
Tsai
Department of Internal Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Jyh-Ming
JM
Liou
Department of Internal Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Mei-Jyh
MJ
Chen
Department of Internal Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Chien-Chuan
CC
Chen
Department of Oncology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Sung-Hsin
SH
Kuo
Department of Surgery, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
I-Rue
IR
Lai
Department of Oncology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Kun-Huei
KH
Yeh
Department of Surgery, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Ming-Tsan
MT
Lin
Department of Internal Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Hsiu-Po
HP
Wang
Department of Oncology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Ann-Lii
AL
Cheng
Department of Internal Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.|School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
Jaw-Town
JT
Lin
Department of Pathology and Forensic Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Chia-Tung
CT
Shun
Department of Internal Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Ming-Shiang
MS
Wu
D000230:Adenocarcinoma / Q000150:complications* / Q000201:enzymology / Q000382:microbiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005757:Gastritis, Atrophic / Q000150:complications* / Q000201:enzymology / Q000382:microbiology*; D016481:Helicobacter Infections / Q000150:complications* / Q000201:enzymology; D016480:Helicobacter pylori; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood; D020115:Pepsinogen C / Q000097:blood; D011379:Prognosis; D013274:Stomach Neoplasms / Q000150:complications* / Q000201:enzymology / Q000382:microbiology*; D055815:Young Adult
D020115:Pepsinogen C; D020116:Pepsinogen A