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Multicenter Study
. 2025 Mar 13;25(1):460.
doi: 10.1186/s12885-025-13840-7.

Effect of Helicobacter pylori infection on survival outcomes of patients undergoing radical gastrectomy after neoadjuvant chemotherapy: a multicenter study in China

Qi-Chen He #  1   2   3   4 , Ze-Ning Huang #  1   2   3   4 , Chen-Bin Lv #  5 , Yong-He Wu  6 , Wen-Wu Qiu  1   2   3   4 , Yu-Bin Ma  7 , Ju Wu  1   2   3   4   8 , Chang-Yue Zheng  1   2   3   4   9 , Guo-Sheng Lin  1   2   3   4 , Ping Li  1   2   3   4 , Jia-Bin Wang  1   2   3   4 , Jian-Xian Lin  1   2   3   4 , Mi Lin  1   2   3   4 , Ru-Hong Tu  1   2   3   4 , Chao-Hui Zheng  1   2   3   4 , Chang-Ming Huang  10   11   12   13 , Long-Long Cao  14   15   16   17 , Jian-Wei Xie  18   19   20   21
Affiliations
Multicenter Study

Effect of Helicobacter pylori infection on survival outcomes of patients undergoing radical gastrectomy after neoadjuvant chemotherapy: a multicenter study in China

Qi-Chen He et al. BMC Cancer. .

Abstract

Background: Neoadjuvant chemotherapy (NAC) has been confirmed to improve the prognosis of patients with advanced gastric cancer (AGC). However, no study has investigated whether Helicobacter pylori (HP) infection affects the postoperative survival of patients who receive NAC.

Methods: This retrospective cohort study included 307 patients with AGC who underwent laparoscopic radical gastrectomy after NAC at three hospitals in China between January 1, 2016, and April 31, 2020. Cox regression was used to assess prognostic factors for survival. Kaplan-Meier was used for survival analysis.

Results: The HP + and the HP- group included 141 and 166 cases. The 3-year overall survival (OS) and disease-free survival (DFS) of the HP + group were significantly better than the HP- group (3-year OS: 75.9% vs. 60.2%, 3-year DFS: 70.2% vs. 52.3%; All P < 0.001). For the HP + group, ypTNM Stage III (HR, 4.00; 95% CI, 1.11-14.39; P = 0.034), NAC ≥ 4 cycles (HR, 0.43; 95% CI, 0.20-0.90; P = 0.026), and adjuvant chemotherapy (AC) ≥ 4 cycles (HR, 0.20; 95% CI, 0.09-0.48; P < 0.001) are independent prognostic factors for OS. In the cohort of HP + patients who received ≥ 4 cycles of NAC, the prognosis of patients who received ≥ 4 cycles of AC after surgery was better than that of patients who received < 4 cycles of AC (3-year OS: 92.5% vs 71.4%; P = 0.042).

Conclusions: Following NAC, HP + patients with AGC exhibit better prognosis than that of HP- counterparts. For potentially resectable HP + AGC patients, radical surgery following ≥ 4 cycles of NAC with ≥ 4 cycles of sequential AC might be recommended to improve survival.

Keywords: Helicobacter pylori; Gastrectomy; Gastric cancer; Neoadjuvant chemotherapy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol has been reviewed and approved by the Ethics Committees of Fujian Medical University Union Hospital, Fujian Medical University Affiliated Zhangzhou Hospital, and Qinghai University Affiliated Hospital (Number of IRB: 2024KY090), in accordance with the ethical regulations for biomedical research in the People's Republic of China. All participants from the three hospitals signed written informed consent forms prior to their inclusion in the study. The consent forms clearly included the following elements: 1) the purpose, methods, and expected duration of the study; 2) foreseeable risks and potential benefits; 3) the voluntary nature of participation and the right to withdraw unconditionally; and 4) data anonymization and confidentiality measures. For patients unable to provide direct consent (such as those in a coma), we obtained proxy consent from legal guardians or close relatives. All patient data are stored in a de-identified coded format, with access to the original data restricted to core members of the research team. When the study results are published, no identifiable personal information will be included. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Diagram of study population in all patients
Fig. 2
Fig. 2
Kaplan–Meier curves of overall survival and disease-free survival for H. pylori positive vs H. pylori negative after surgery. A Kaplan–Meier curves for overall survival; B Kaplan–Meier curves for disease-free survival
Fig. 3
Fig. 3
Competing risk model between H. pylori positive and H. pylori negative in all patients. A Competing risk model in overall recurrence; B Competing risk model in distant recurrence; C, Competing risk model in peritoneum recurrence
Fig. 4
Fig. 4
Dynamic recurrence hazard rate plot. A Dynamic recurrence hazard rate plot in overall recurrence patients; B Dynamic recurrence hazard rate plot in distant recurrence patients; C Dynamic recurrence hazard rate plot in peritoneum recurrence patients
Fig. 5
Fig. 5
Substratified analysis of multi-variable forest plots for overall survival and disease-free survival in all patients. A Multi-variable forest plots for overall survival; B Multi-variable forest plots for disease-free survival
Fig. 6
Fig. 6
Kaplan–Meier curves for overall survival stratified by AC between H. pylori positive and H. pylori negative patients. A Kaplan–Meier curves for overall survival in H. pylori positive patients; B Kaplan–Meier curves for overall survival in H. pylori negative patients
See this image and copyright information in PMC

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