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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2016

01-04-2016 | Gastrointestinal Oncology

Preoperative Helicobacter pylori Infection is Associated with Increased Survival After Resection of Gastric Adenocarcinoma

Authors: Lauren M. Postlewait, MD, Malcolm H. Squires III, MD, MS, David A. Kooby, MD, George A. Poultsides, MD, Sharon M. Weber, MD, Mark Bloomston, MD, Ryan C. Fields, MD, Timothy M. Pawlik, MD, MPH, PhD, Konstantinos I. Votanopoulos, MD, Carl R. Schmidt, MD, Aslam Ejaz, MD, Alexandra W. Acher, BS, David J. Worhunsky, MD, Neil Saunders, MD, Douglas Swords, MD, Linda X. Jin, MD, Clifford S. Cho, MD, Emily R. Winslow, MD, Kenneth Cardona, MD, Charles A. Staley, MD, Shishir K. Maithel, MD

Published in: Annals of Surgical Oncology | Issue 4/2016

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Abstract

Background

Limited data exist on the prognosis of preoperative Helicobacter pylori (H. pylori) infection in gastric adenocarcinoma (GAC).

Methods

Patients who underwent curative-intent resection for GAC from 2000 to 2012 at seven academic institutions comprising the United States Gastric Cancer Collaborative were included in the study. The primary end points of the study were overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS).

Results

Of 559 patients, 104 (18.6 %) who tested positive for H. pylori were younger (62.1 vs 65.1 years; p = 0.041), had a higher frequency of distal tumors (82.7 vs 71.9 %; p = 0.033), and had higher rates of adjuvant radiation therapy (47.0 vs 34.9 %; p = 0.032). There were no differences in American Society of Anesthesiology (ASA) class, margin status, grade, perineural invasion, lymphovascular invasion, nodal metastases, or tumor-node-metastasis (TNM) stage. H. pylori positivity was associated with longer OS (84.3 vs 44.2 months; p = 0.008) for all patients. This relationship with OS persisted in the multivariable analysis (HR 0.54; 95 % CI 0.30–0.99; p = 0.046). H. pylori was not associated with RFS or DSS in all patients. In the stage 3 patients, H. pylori was associated with longer OS (44.5 vs 24.7 months; p = 0.018), a trend of longer RFS (31.4 vs 21.6 months; p = 0.232), and longer DSS (44.8 vs 27.2 months; p = 0.034).

Conclusions

Patients with and without preoperative H. pylori infection had few differences in adverse pathologic features at the time of gastric adenocarcinoma resection. Despite similar disease presentations, preoperative H. pylori infection was independently associated with improved OS. Further studies examining the interaction between H. pylori and tumor immunology and genetics are merited.
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Metadata
Title
Preoperative Helicobacter pylori Infection is Associated with Increased Survival After Resection of Gastric Adenocarcinoma
Authors
Lauren M. Postlewait, MD
Malcolm H. Squires III, MD, MS
David A. Kooby, MD
George A. Poultsides, MD
Sharon M. Weber, MD
Mark Bloomston, MD
Ryan C. Fields, MD
Timothy M. Pawlik, MD, MPH, PhD
Konstantinos I. Votanopoulos, MD
Carl R. Schmidt, MD
Aslam Ejaz, MD
Alexandra W. Acher, BS
David J. Worhunsky, MD
Neil Saunders, MD
Douglas Swords, MD
Linda X. Jin, MD
Clifford S. Cho, MD
Emily R. Winslow, MD
Kenneth Cardona, MD
Charles A. Staley, MD
Shishir K. Maithel, MD
Publication date
01-04-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4953-x

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