Treatment for H. pylori infection may yield ‘notable’ survival benefits in gastric cancer
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Key takeaways:
- Overall and disease-free survival among patients treated for Helicobacter pylori infection was 94.1% and 84.9% at 5 years.
- Results highlight the importance of H. pylori screening and treatment before surgery.
Treatment for Helicobacter pylori was associated with improved overall and disease-free survival among patients with confirmed infection and gastric cancer who underwent gastrectomy, according to data published in JAMA Network Open.
“Numerous studies have provided substantial evidence that eradicating H. pylori in healthy individuals can reduce the incidence of precancerous lesions for gastric cancer, subsequently decreasing the likelihood of developing gastric cancer,” Zhoukai Zhao, MD, of the department of gastric surgery at Sun Yat-sen University Cancer Center, and colleagues wrote. “In addition, several studies have reported that patients with H. pylori-positive gastric cancer have better survival outcomes after gastric cancer surgery compared with those with H. pylori-negative gastric cancer. “
They continued: “The relationship between H. pylori infection and survival rates with gastric cancer is not yet fully elucidated, limited by contradictory results, small sample size and a paucity of high-quality related research.”
In a retrospective cohort study, Zhao and colleagues enrolled 1,293 patients with gastric cancer (median age, 59 years; median BMI, 22; 66.5% men) and confirmed H. pylori infection who underwent curative gastrectomy between 2010 and 2018. Researchers divided patients into anti-H. pylori (n = 125) and non-anti-H. pylori (n = 1,168) treatment groups and investigated overall and disease-free survival between groups. Treatment consisted of a 14-day regimen of amoxicillin, clarithromycin and omeprazole in the perioperative period.
After propensity score matching, there were 124 patients in the treatment group and 364 in the non-treatment group. Patients were monitored for up to 10 years, with a median follow-up of 40.4 months.
According to study results, overall survival was 95.9% (95% CI, 92.5-99.5) at 3 years and 94.1% (95% CI, 89.3-99.2) at 5 years in the treatment group vs. 81.4% (95% CI, 79-83.8) and 73.8% (95% CI, 70.7-77), respectively, in the non-treatment group, a significant difference before (HR = 0.33; 95% CI, 0.18-0.6) and after matching (HR = 0.5; 95% CI, 0.26-0.99).
The treatment group also had better disease-free survival rates of 94.5% (95% CI, 90.3-98.9) at 3 years and 84.9% (95% CI, 75.6-95.4) at 5 years vs. 70% (95% CI, 67.1-73.1) and 59.2% (95% CI, 55.4-63.3), respectively, in the non-treatment group. As with overall survival, the advantage in disease-free survival was significant for the treatment group before (HR = 0.29; 95% CI, 0.17-0.5) and after (HR = 0.48; 95% CI, 0.27-0.87) matching.
Further, anti-H. pylori treatment was associated with greater overall survival benefits (HR = 0.49; 95% CI, 0.24-0.99) among patients with TNM stage II/III disease who also received adjuvant chemotherapy, while anti-H. pylori treatment was not linked to survival benefits in those who did not receive adjuvant chemotherapy (HR = 0.29; 95% CI, 0.04-2.08).
“This study’s findings indicate that for patients with gastric cancer and H. pylori infection before surgery, undergoing anti-H. pylori treatment may be associated with notable survival advantages,” Zhao and colleagues wrote. “We suggest expanding the scope of future H. pylori treatment guidelines and implementing thorough screening and treatment for H. pylori in patients undergoing surgical treatment for gastric cancer.”
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