Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
JAMA Netw Open. 2024 Mar 4;7(3):e243812. doi: 10.1001/jamanetworkopen.2024.3812.
Whether anti-Helicobacter pylori treatment can provide survival benefits for patients with gastric cancer who are diagnosed with H pylori infection is an area with limited research.
To explore the potential survival benefits of anti-H pylori treatment after radical gastrectomy in patients with gastric cancer and presurgical confirmation of H pylori infection.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted using data from patients with gastric cancer treated between January 1, 2010, and December 31, 2018, and followed up for outcome ascertainment until May 19, 2021. Propensity score matching was performed in patients treated with or without anti-H pylori treatment. This study involved a single institute in a comprehensive cancer treatment and research center located in Guangzhou, Guangdong Province, China. The study included patients with gastric or esophagogastric junction adenocarcinoma who underwent curative gastrectomy with D2 lymphadenectomy and tested positive for H pylori infection. Data were analyzed from March to June 2023.
Anti-H pylori treatment, which primarily includes triple therapy regimens consisting of amoxicillin, clarithromycin, and omeprazole for 14 days.
Clinical outcomes, including overall survival (OS) and disease-free survival (DFS), were analyzed by Kaplan-Meier method, log-rank test, and Cox proportional hazards regression model. Subgroup analysis based on crucial clinical information was also conducted.
All 1293 patients (median [IQR] age, 59 [50-65] years; 860 [66.5%] male) were divided into 2 groups, with 125 patients in the anti-H pylori treatment group and 1168 patients in the non-anti-H pylori treatment group based on whether they received anti-H pylori treatment during the perioperative period and the follow-up. 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). The survival benefit remained after propensity score matching (HR, 0.50; 95% CI, 0.26-0.99; P = .048). Multivariable analysis for OS and DFS further showed the survival benefit of anti-H pylori treatment, with HRs of 0.38 (95% CI, 0.17-0.87; P = .02) and 0.48 (95% CI, 0.28-0.83; P = .008), respectively. Among patients with TNM stage II/III disease who received adjuvant chemotherapy, anti-H pylori treatment was associated with survival benefits (OS: HR, 0.49; 95% CI, 0.24-0.99; P = .046), whereas among those who did not receive adjuvant chemotherapy, anti-H pylori treatment was not associated with survival benefits (OS: HR, 0.29; 95% CI, 0.04-2.08; P = .22).
This cohort study indicates that anti-H pylori treatment may be associated with improved survival in patients with gastric cancer who have H pylori infections. The study reinforces the importance of including H pylori screening and treatment in the surgical treatment of these patients.
根治性胃切除术后抗幽门螺杆菌治疗是否能为诊断为幽门螺杆菌感染的胃癌患者提供生存获益，这是一个研究有限的领域。
探讨术前确认幽门螺杆菌感染的胃癌患者根治性胃切除术后抗幽门螺杆菌治疗的潜在生存获益。
设计、设置和参与者：本回顾性队列研究使用 2010 年 1 月 1 日至 2018 年 12 月 31 日期间接受治疗的胃癌患者的数据，并进行了随访，以确定结果，直到 2021 年 5 月 19 日。对接受或未接受抗幽门螺杆菌治疗的患者进行倾向评分匹配。这项研究涉及位于中国广东省广州市的一个综合性癌症治疗和研究中心的一家医院。研究包括接受根治性胃切除术和 D2 淋巴结清扫术且幽门螺杆菌感染检测阳性的胃或食管胃交界腺癌患者。数据于 2023 年 3 月至 6 月进行分析。
抗幽门螺杆菌治疗主要包括阿莫西林、克拉霉素和奥美拉唑的三联疗法，疗程为 14 天。
通过 Kaplan-Meier 法、对数秩检验和 Cox 比例风险回归模型分析临床结局，包括总生存（OS）和无病生存（DFS）。还进行了基于关键临床信息的亚组分析。
所有 1293 名患者（中位数[IQR]年龄，59 [50-65] 岁；860 [66.5%] 为男性）分为 2 组，根据围手术期和随访期间是否接受抗幽门螺杆菌治疗，125 名患者在抗幽门螺杆菌治疗组，1168 名患者在非抗幽门螺杆菌治疗组。生存分析显示，抗幽门螺杆菌组的 5 年 OS 率为 94.1%（95%CI，89.3%-99.2%），非抗幽门螺杆菌组为 73.8%（95%CI，70.7%-77.0%），两组的 HR 为 0.33（95%CI，0.18-0.60；P < .001）。在进行倾向评分匹配后，生存获益仍然存在（HR，0.50；95%CI，0.26-0.99；P = .048）。OS 和 DFS 的多变量分析进一步显示了抗幽门螺杆菌治疗的生存获益，HR 分别为 0.38（95%CI，0.17-0.87；P = .02）和 0.48（95%CI，0.28-0.83；P = .008）。在接受辅助化疗的 TNM 分期 II/III 期患者中，抗幽门螺杆菌治疗与生存获益相关（OS：HR，0.49；95%CI，0.24-0.99；P = .046），而在未接受辅助化疗的患者中，抗幽门螺杆菌治疗与生存获益无关（OS：HR，0.29；95%CI，0.04-2.08；P = .22）。
本队列研究表明，抗幽门螺杆菌治疗可能与幽门螺杆菌感染的胃癌患者的生存改善相关。该研究强调了在这些患者的手术治疗中纳入幽门螺杆菌筛查和治疗的重要性。
