OBJECTIVE

Helicobacter pylori (H. pylori) are classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC), highlighting its well-established role in gastric carcinogenesis. While previous studies and systematic reviews suggest that H. pylori eradication may lower the incidence and mortality of gastric cancer, the evolving body of evidence necessitates continual reassessment. In light of newly available data, we conducted a comprehensive meta-analysis to evaluate the association between H. pylori eradication therapy and gastric cancer risk, aiming to strengthen the evidence base and inform clinical decision-making.

METHOD

We systematically searched the Cochrane Library, PubMed, Web of Science, and Embase up to December 2024, including only randomized controlled trials (RCTs) while excluding non-RCT studies. The target population comprised adults diagnosed with H. pylori infection who were either healthy or had previously undergone gastrectomy for gastric tumors. Eradication therapy served as the intervention, while placebo was the control. Eligible studies had a treatment duration exceeding seven days and a follow-up period of more than three years. The Cochrane risk-of-bias tool was used to assess methodological quality, and effect estimates were expressed as relative risk (RR) and the number needed to treat (NNT).

OUTCOMES

A total of 11 RCTs encompassing 104,786 individuals were analyzed. The meta-analysis revealed that H. pylori eradication significantly reduced gastric cancer risk (RR: 0.61; 95% CI: 0.47-0.79; NNT = 332). Subgroup analysis indicated that among healthy adults, the relative risk (RR) for the occurrence of gastric cancer was 0.67 (95% CI: 0.48-0.93; NNT = 476). In individuals who had undergone endoscopic mucosal resection, the reduction was even more pronounced (RR: 0.51; 95% CI: 0.36-0.71; NNT = 21). Although stomach cancer-specific mortality showed a slight decline (RR: 0.84; 95% CI: 0.69-1.01), all-cause mortality remained statistically unchanged (RR: 1.00; 95% CI: 0.89-1.13).

CONCLUSION

Our findings support H. pylori eradication as an effective strategy for reducing gastric cancer incidence, particularly in East Asian populations. While the effect on overall mortality remains inconclusive, the observed reduction in gastric cancer-related mortality highlights the potential clinical significance of eradication therapy as a preventive measure. Further well-designed, long-term studies are warranted to reinforce the evidence base and optimize clinical recommendations.