The impact of Helicobacter pylori infection on prognosis in patients with postgastrectomy gastric cancer: A systematic review and meta-analysis.

Abstract

Helicobacter pylori infection is a recognized risk factor for gastric cancer, but its impact on postgastrectomy prognosis remains unclear. This study evaluated the prognostic significance of H pylori infection in patients with gastric cancer after gastrectomy. A systematic review of English-language studies published by August 2024 was conducted using PubMed, Embase, the Cochrane Library, and Web of Science. Outcomes included overall survival, disease-free survival, and recurrence-free survival. Hazard ratios with 95% confidence intervals were calculated. Subgroup analyses considered the geographical location of the study, patient age, sex, H pylori eradication, and H pylori diagnostic methods. Heterogeneity was evaluated using I² and Q tests, and publication bias with funnel plots and the Begg or Egger test. Of 2,182 screened articles, 23 studies (10,259 patients) met inclusion criteria. H pylori infection was not significantly associated with overall survival (hazard ratio, 0.82; 95% confidence interval, 0.63-1.07; P = .144), disease-free survival (hazard ratio, 0.98; 95% confidence interval, 0.65-1.47; P = .921), or recurrence-free survival (hazard ratio, 0.92; 95% confidence interval, 0.53-1.60; P = .767). However, infection improved disease-free survival in patients without eradication (hazard ratio, 0.70; 95% confidence interval, 0.55-0.90; P = .005). In patients younger than 60 years, infection or noneradication predicted worse disease-free survival (hazard ratio, 2.04; 95% confidence interval, 1.34-3.11; P = .001). H pylori infection did not significantly affect postgastrectomy prognosis overall, although its impact varies by patient subgroup. Further research is needed to confirm these findings.