Preoperative Helicobacter pylori Infection is Associated with Increased Survival After Resection of Gastric Adenocarcinoma

Lauren M. Postlewait, Malcolm H. Squires, David A. Kooby, George A. Poultsides, Sharon M. Weber, Mark Bloomston, Ryan C. Fields, Timothy M. Pawlik, Konstantinos I. Votanopoulos, Carl R. Schmidt, Aslam Ejaz, Alexandra W. Acher, David J. Worhunsky, Neil Saunders, Douglas Swords, Linda X. Jin, Clifford S. Cho, Emily R. Winslow, Kenneth Cardona, Charles A. StaleyShishir K. Maithel

Research output: Contribution to journalArticle

Abstract

Background: Limited data exist on the prognosis of preoperative Helicobacter pylori (H. pylori) infection in gastric adenocarcinoma (GAC). Methods: Patients who underwent curative-intent resection for GAC from 2000 to 2012 at seven academic institutions comprising the United States Gastric Cancer Collaborative were included in the study. The primary end points of the study were overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS). Results: Of 559 patients, 104 (18.6 %) who tested positive for H. pylori were younger (62.1 vs 65.1 years; p = 0.041), had a higher frequency of distal tumors (82.7 vs 71.9 %; p = 0.033), and had higher rates of adjuvant radiation therapy (47.0 vs 34.9 %; p = 0.032). There were no differences in American Society of Anesthesiology (ASA) class, margin status, grade, perineural invasion, lymphovascular invasion, nodal metastases, or tumor-node-metastasis (TNM) stage. H. pylori positivity was associated with longer OS (84.3 vs 44.2 months; p = 0.008) for all patients. This relationship with OS persisted in the multivariable analysis (HR 0.54; 95 % CI 0.30–0.99; p = 0.046). H. pylori was not associated with RFS or DSS in all patients. In the stage 3 patients, H. pylori was associated with longer OS (44.5 vs 24.7 months; p = 0.018), a trend of longer RFS (31.4 vs 21.6 months; p = 0.232), and longer DSS (44.8 vs 27.2 months; p = 0.034). Conclusions: Patients with and without preoperative H. pylori infection had few differences in adverse pathologic features at the time of gastric adenocarcinoma resection. Despite similar disease presentations, preoperative H. pylori infection was independently associated with improved OS. Further studies examining the interaction between H. pylori and tumor immunology and genetics are merited.

Original languageEnglish (US)
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Nov 9 2015

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Helicobacter Infections
Helicobacter pylori
Stomach
Adenocarcinoma
Survival
Recurrence
Disease-Free Survival
Neoplasm Metastasis
Neoplasms
Anesthesiology
Allergy and Immunology
Stomach Neoplasms
Radiotherapy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Postlewait, L. M., Squires, M. H., Kooby, D. A., Poultsides, G. A., Weber, S. M., Bloomston, M., ... Maithel, S. K. (Accepted/In press). Preoperative Helicobacter pylori Infection is Associated with Increased Survival After Resection of Gastric Adenocarcinoma. Annals of Surgical Oncology. https://doi.org/10.1245/s10434-015-4953-x

Preoperative Helicobacter pylori Infection is Associated with Increased Survival After Resection of Gastric Adenocarcinoma. / Postlewait, Lauren M.; Squires, Malcolm H.; Kooby, David A.; Poultsides, George A.; Weber, Sharon M.; Bloomston, Mark; Fields, Ryan C.; Pawlik, Timothy M.; Votanopoulos, Konstantinos I.; Schmidt, Carl R.; Ejaz, Aslam; Acher, Alexandra W.; Worhunsky, David J.; Saunders, Neil; Swords, Douglas; Jin, Linda X.; Cho, Clifford S.; Winslow, Emily R.; Cardona, Kenneth; Staley, Charles A.; Maithel, Shishir K.

In: Annals of Surgical Oncology, 09.11.2015.

Research output: Contribution to journalArticle

Postlewait, LM, Squires, MH, Kooby, DA, Poultsides, GA, Weber, SM, Bloomston, M, Fields, RC, Pawlik, TM, Votanopoulos, KI, Schmidt, CR, Ejaz, A, Acher, AW, Worhunsky, DJ, Saunders, N, Swords, D, Jin, LX, Cho, CS, Winslow, ER, Cardona, K, Staley, CA & Maithel, SK 2015, 'Preoperative Helicobacter pylori Infection is Associated with Increased Survival After Resection of Gastric Adenocarcinoma', Annals of Surgical Oncology. https://doi.org/10.1245/s10434-015-4953-x
Postlewait, Lauren M. ; Squires, Malcolm H. ; Kooby, David A. ; Poultsides, George A. ; Weber, Sharon M. ; Bloomston, Mark ; Fields, Ryan C. ; Pawlik, Timothy M. ; Votanopoulos, Konstantinos I. ; Schmidt, Carl R. ; Ejaz, Aslam ; Acher, Alexandra W. ; Worhunsky, David J. ; Saunders, Neil ; Swords, Douglas ; Jin, Linda X. ; Cho, Clifford S. ; Winslow, Emily R. ; Cardona, Kenneth ; Staley, Charles A. ; Maithel, Shishir K. / Preoperative Helicobacter pylori Infection is Associated with Increased Survival After Resection of Gastric Adenocarcinoma. In: Annals of Surgical Oncology. 2015.
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abstract = "Background: Limited data exist on the prognosis of preoperative Helicobacter pylori (H. pylori) infection in gastric adenocarcinoma (GAC). Methods: Patients who underwent curative-intent resection for GAC from 2000 to 2012 at seven academic institutions comprising the United States Gastric Cancer Collaborative were included in the study. The primary end points of the study were overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS). Results: Of 559 patients, 104 (18.6 {\%}) who tested positive for H. pylori were younger (62.1 vs 65.1 years; p = 0.041), had a higher frequency of distal tumors (82.7 vs 71.9 {\%}; p = 0.033), and had higher rates of adjuvant radiation therapy (47.0 vs 34.9 {\%}; p = 0.032). There were no differences in American Society of Anesthesiology (ASA) class, margin status, grade, perineural invasion, lymphovascular invasion, nodal metastases, or tumor-node-metastasis (TNM) stage. H. pylori positivity was associated with longer OS (84.3 vs 44.2 months; p = 0.008) for all patients. This relationship with OS persisted in the multivariable analysis (HR 0.54; 95 {\%} CI 0.30–0.99; p = 0.046). H. pylori was not associated with RFS or DSS in all patients. In the stage 3 patients, H. pylori was associated with longer OS (44.5 vs 24.7 months; p = 0.018), a trend of longer RFS (31.4 vs 21.6 months; p = 0.232), and longer DSS (44.8 vs 27.2 months; p = 0.034). Conclusions: Patients with and without preoperative H. pylori infection had few differences in adverse pathologic features at the time of gastric adenocarcinoma resection. Despite similar disease presentations, preoperative H. pylori infection was independently associated with improved OS. Further studies examining the interaction between H. pylori and tumor immunology and genetics are merited.",
author = "Postlewait, {Lauren M.} and Squires, {Malcolm H.} and Kooby, {David A.} and Poultsides, {George A.} and Weber, {Sharon M.} and Mark Bloomston and Fields, {Ryan C.} and Pawlik, {Timothy M.} and Votanopoulos, {Konstantinos I.} and Schmidt, {Carl R.} and Aslam Ejaz and Acher, {Alexandra W.} and Worhunsky, {David J.} and Neil Saunders and Douglas Swords and Jin, {Linda X.} and Cho, {Clifford S.} and Winslow, {Emily R.} and Kenneth Cardona and Staley, {Charles A.} and Maithel, {Shishir K.}",
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T1 - Preoperative Helicobacter pylori Infection is Associated with Increased Survival After Resection of Gastric Adenocarcinoma

AU - Postlewait, Lauren M.

AU - Squires, Malcolm H.

AU - Kooby, David A.

AU - Poultsides, George A.

AU - Weber, Sharon M.

AU - Bloomston, Mark

AU - Fields, Ryan C.

AU - Pawlik, Timothy M.

AU - Votanopoulos, Konstantinos I.

AU - Schmidt, Carl R.

AU - Ejaz, Aslam

AU - Acher, Alexandra W.

AU - Worhunsky, David J.

AU - Saunders, Neil

AU - Swords, Douglas

AU - Jin, Linda X.

AU - Cho, Clifford S.

AU - Winslow, Emily R.

AU - Cardona, Kenneth

AU - Staley, Charles A.

AU - Maithel, Shishir K.

PY - 2015/11/9

Y1 - 2015/11/9

N2 - Background: Limited data exist on the prognosis of preoperative Helicobacter pylori (H. pylori) infection in gastric adenocarcinoma (GAC). Methods: Patients who underwent curative-intent resection for GAC from 2000 to 2012 at seven academic institutions comprising the United States Gastric Cancer Collaborative were included in the study. The primary end points of the study were overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS). Results: Of 559 patients, 104 (18.6 %) who tested positive for H. pylori were younger (62.1 vs 65.1 years; p = 0.041), had a higher frequency of distal tumors (82.7 vs 71.9 %; p = 0.033), and had higher rates of adjuvant radiation therapy (47.0 vs 34.9 %; p = 0.032). There were no differences in American Society of Anesthesiology (ASA) class, margin status, grade, perineural invasion, lymphovascular invasion, nodal metastases, or tumor-node-metastasis (TNM) stage. H. pylori positivity was associated with longer OS (84.3 vs 44.2 months; p = 0.008) for all patients. This relationship with OS persisted in the multivariable analysis (HR 0.54; 95 % CI 0.30–0.99; p = 0.046). H. pylori was not associated with RFS or DSS in all patients. In the stage 3 patients, H. pylori was associated with longer OS (44.5 vs 24.7 months; p = 0.018), a trend of longer RFS (31.4 vs 21.6 months; p = 0.232), and longer DSS (44.8 vs 27.2 months; p = 0.034). Conclusions: Patients with and without preoperative H. pylori infection had few differences in adverse pathologic features at the time of gastric adenocarcinoma resection. Despite similar disease presentations, preoperative H. pylori infection was independently associated with improved OS. Further studies examining the interaction between H. pylori and tumor immunology and genetics are merited.

AB - Background: Limited data exist on the prognosis of preoperative Helicobacter pylori (H. pylori) infection in gastric adenocarcinoma (GAC). Methods: Patients who underwent curative-intent resection for GAC from 2000 to 2012 at seven academic institutions comprising the United States Gastric Cancer Collaborative were included in the study. The primary end points of the study were overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS). Results: Of 559 patients, 104 (18.6 %) who tested positive for H. pylori were younger (62.1 vs 65.1 years; p = 0.041), had a higher frequency of distal tumors (82.7 vs 71.9 %; p = 0.033), and had higher rates of adjuvant radiation therapy (47.0 vs 34.9 %; p = 0.032). There were no differences in American Society of Anesthesiology (ASA) class, margin status, grade, perineural invasion, lymphovascular invasion, nodal metastases, or tumor-node-metastasis (TNM) stage. H. pylori positivity was associated with longer OS (84.3 vs 44.2 months; p = 0.008) for all patients. This relationship with OS persisted in the multivariable analysis (HR 0.54; 95 % CI 0.30–0.99; p = 0.046). H. pylori was not associated with RFS or DSS in all patients. In the stage 3 patients, H. pylori was associated with longer OS (44.5 vs 24.7 months; p = 0.018), a trend of longer RFS (31.4 vs 21.6 months; p = 0.232), and longer DSS (44.8 vs 27.2 months; p = 0.034). Conclusions: Patients with and without preoperative H. pylori infection had few differences in adverse pathologic features at the time of gastric adenocarcinoma resection. Despite similar disease presentations, preoperative H. pylori infection was independently associated with improved OS. Further studies examining the interaction between H. pylori and tumor immunology and genetics are merited.

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