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Review
. 2023 Jan 18;15(3):595.
doi: 10.3390/cancers15030595.

Helicobacter Species and Hepato-Biliary Tract Malignancies: A Systematic Review and Meta-Analysis

Beatriz Gros  1   2 , Alberto Gómez Pérez  1 , María Pleguezuelo  1   2 , Francisco Javier Serrano Ruiz  1   2 , Manuel de la Mata  1   2   3 , Manuel Rodríguez-Perálvarez  1   2   3
Affiliations
Review

Helicobacter Species and Hepato-Biliary Tract Malignancies: A Systematic Review and Meta-Analysis

Beatriz Gros et al. Cancers (Basel). .

Abstract

Helicobacter species may cause chronic inflammation of the biliary tract, but its relationship with cancer is controversial. We performed a systematic review and meta-analysis to evaluate the association between Helicobacter species and hepatobiliary tract malignancies. Twenty-six studies (4083 patients) were included in qualitative synthesis, and 18 studies (n = 1895 qualified for meta-analysis. All studies were at high-intermediate risk of bias. Most studies combined several direct microbiological methods, mostly PCR (23 studies), culture (8 studies), and/or CLOtest (5 studies). Different specimens alone or in combination were investigated, most frequently bile (16 studies), serum (7 studies), liver/biliary tissue (8 studies), and gastric tissue (3 studies). Patients with Helicobacter species infection had an increased risk of hepatobiliary tract malignancies (OR = 3.61 [95% CI 2.18-6.00]; p < 0.0001), with high heterogeneity in the analysis (I2 = 61%; p = 0.0003). This effect was consistent when Helicobacter was assessed in bile (OR = 3.57 [95% CI 1.73-7.39]; p = 0.0006), gastric tissue (OR = 42.63 [95% CI 5.25-346.24]; p = 0.0004), liver/biliary tissue (OR = 4.92 [95% CI 1.90-12.76]; p = 0.001) and serum (OR = 1.38 [95% CI 1.00-1.90]; p = 0.05). Heterogeneity was reduced in these sub-analyses (I2 = 0-27%; p = ns), except for liver/biliary tissue (I2 = 57%; p = 0.02). In conclusion, based on low-certainty data, Helicobacter species chronic infection is associated with a tripled risk of hepatobiliary tract malignancy. Prospective studies are required to delineate public health interventions.

Keywords: Helicobacter; cancer; cholangiocarcinoma; neoplasms.

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Conflict of interest statement

M.R.-P. received lecture fees from Astellas, Chiesi, and Advanz pharma, none of them related to the present work. The remaining authors have no conflict of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of the literature search and study selection.
Figure 2
Figure 2
Forest plot of 18 studies evaluating the risk of hepatobiliary tract malignancies according to the presence or absence of Helicobacter spp. infection detected by direct microbiological methods using a random-effects model.
Figure 3
Figure 3
Funnel plot of 18 studies, including evaluating the risk of hepatobiliary tract malignancies according to the presence or absence of Helicobacter spp. infection detected by direct microbiological methods using a random-effects model.
Figure 4
Figure 4
Forest plots of studies evaluating the risk of hepatobiliary tract malignancies according to the presence or absence of Helicobacter spp. infection assessed in different types of specimens: panel (A): bile; panel (B): gastric tissue; panel (C): liver/biliary tissue; panel (D): serum.
Figure 4
Figure 4
Forest plots of studies evaluating the risk of hepatobiliary tract malignancies according to the presence or absence of Helicobacter spp. infection assessed in different types of specimens: panel (A): bile; panel (B): gastric tissue; panel (C): liver/biliary tissue; panel (D): serum.
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