Nishizuka Satoshi S, Tamura Gen, Nakatochi Masahiro, Fukushima Norimasa, Ohmori Yukimi, Sumida Chihiro, Iwaya Takeshi, Takahashi Takashi, Koeda Keisuke
Molecular Therapeutics Laboratory, Iwate Medical University School of Medicine, Morioka, Japan.
Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
J Surg Oncol. 2018 Apr;117(5):947-956. doi: 10.1002/jso.24977. Epub 2018 Jan 22.
Limited information exists regarding beneficial effects of Helicobacter pylori. To examine the effect in advanced gastric cancer, we compared survival for patients treated with surgery-only or adjuvant chemotherapy on the basis of H. pylori infection status.
A cohort of 491 patients who underwent R0 resection for locally advanced gastric cancer between 2000 and 2009 at 12 institutions in northern Japan was included. H. pylori infection status, was assessed from paraffin-embedded formalin-fixed samples. Overall survival (OS) and disease-free survival (DFS) in surgery-only (Surgery) and adjuvant chemotherapy (S-1) groups were analyzed. A propensity score matching was employed to correct for confounding factors by indication.
H. pylori infection was positive in 175 patients and negative in 316 patients. H. pylori-positive patients showed significantly better survival than H. pylori-negative patients in both OS (hazard ratio [HR] 0.593, 95% confidence interval [CI] 0.417-0.843; P = 0.003]) and DFS (HR 0.679, 95%CI 0.492-0.937; P = 0.018). Propensity score matching further confirmed that S-1 was virtually only effective when tumors were H. pylori-positive.
The favorable outcome of H. pylori-positive patients implies that the host immune system is modulated by H. pylori enhancing the chemotherapeutic efficacy.
关于幽门螺杆菌的有益作用，现有信息有限。为研究其在进展期胃癌中的作用，我们根据幽门螺杆菌感染状况，比较了单纯手术治疗或辅助化疗患者的生存率。
纳入了2000年至2009年期间在日本北部12家机构接受R0切除的491例局部进展期胃癌患者。从福尔马林固定石蜡包埋样本中评估幽门螺杆菌感染状况。分析单纯手术组（手术组）和辅助化疗组（S-1组）的总生存期（OS）和无病生存期（DFS）。采用倾向评分匹配法校正因适应证导致的混杂因素。
175例患者幽门螺杆菌感染呈阳性，316例患者呈阴性。幽门螺杆菌阳性患者在总生存期（风险比[HR]0.593，95%置信区间[CI]0.417 - 0.843；P = 0.003）和无病生存期（HR 0.679，95%CI 0.492 - 0.937；P = 0.018）方面均显著优于幽门螺杆菌阴性患者。倾向评分匹配进一步证实，S-1仅在肿瘤为幽门螺杆菌阳性时有效。
幽门螺杆菌阳性患者的良好预后表明，幽门螺杆菌可调节宿主免疫系统，增强化疗疗效。
