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

Background The effect of Helicobaaer-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. Methods Before 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. Findings At a median follow-up of 53(.)0 months (range 1-146), relapse-free survival was 56(.)7 months (95% Cl 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. Interpretation Tumour-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.