Gastric cancer (GC) remains a significant global health concern despite recent declines in incidence. It ranks as the fifth most common cancer and the fourth leading cause of cancer-related deaths worldwide. Helicobacter pylori (H. pylori) infection is a major contributor to chronic gastritis, peptic ulcer, and GC, affecting an estimated 4.4 billion people globally. While studies have shown that eradicating H. pylori can reduce the incidence of precancerous lesions and improve survival outcomes, the impact of anti-H. pylori treatment on postoperative survival in GC patients remains unclear.
A recent retrospective cohort study conducted at the Sun Yat-sen University Cancer Center, China, aimed to shed light on this issue. The study, published in JAMA Oncology, included 1293 patients who underwent curative surgical treatment for GC between 2010 and 2018. All patients had confirmed H. pylori infection before surgery. The researchers investigated the association between postoperative anti-H. pylori treatment and survival outcomes.
The findings revealed that patients who received anti-H. pylori treatment after surgery experienced significant improvements in overall survival (OS) and disease-free survival (DFS) compared to those who did not receive such treatment. The OS rates at 3 and 5 years were notably higher in the anti-H. pylori treatment group; survival analysis showed that the 5-year OS rates were 94.1% (95% CI, 89.3%-99.2%) in the anti–H pylori group and 73.8% (95% CI, 70.7%-77.0%) in the non–anti–H pylori group, and the hazard ratio (HR) of these 2 groups was 0.33 (95% CI, 0.18-0.60; P < .001).
Subgroup analyses indicated that the survival benefits of anti-H. pylori treatment were consistent across most patient subgroups. However, the benefits were particularly pronounced in patients with TNM stage II/III disease. Notably, patients who received adjuvant chemotherapy along with anti-H. pylori treatment experienced enhanced survival benefits compared to those who did not receive chemotherapy.
The study’s lead author emphasised the importance of expanding current H. pylori treatment guidelines to include GC patients undergoing surgical treatment. The results suggest that thorough screening and treatment for H. pylori infection could significantly improve survival outcomes in this patient population.
Despite the study’s compelling findings, several limitations were acknowledged, including its retrospective nature and the potential for selection bias. Nevertheless, the results provide valuable insights into the potential benefits of anti-H. pylori treatment in GC patients and warrant further investigation through prospective studies and randomized clinical trials.
This study represents a significant step forward in understanding the role of H. pylori eradication in improving outcomes for GC patients and underscores the importance of comprehensive management strategies in cancer care.
Paper: Zhao ZZhang RChen G, et al. Anti–Helicobacter pylori Treatment in Patients With Gastric Cancer After Radical Gastrectomy. JAMA Netw Open. 2024;7(3):e243812. doi:10.1001/jamanetworkopen.2024.3812. Access online here.
