Helicobacter pylori as a prognostic indicator after curative resection of gastric carcinoma: a prospective study

SummaryBackgroundThe 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.MethodsBefore 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.FindingsAt 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.InterpretationTumour-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.