幽门螺杆菌感染状态与胃癌预后的关系

Helicobacter pylori infection status as a prognostic indicator for gastric cancer

目的观察幽门螺杆菌(Helicobacter pylori,HP)在胃癌中的现症感染情况,探讨HP感染状态与胃癌患者临床病理特征及预后的关系。方法794例胃癌组织及癌旁组织石蜡切片分别取自第二军医大学长海医院和长征医院,采用改良Giemsa染色法检测切片中HP的感染状态,分析HP感染状态与胃癌患者临床病理参数间的关系;采用单因素分析(Kaplan-Meier法)和多因素分析(Cox比例风险模型)方法研究胃癌患者预后的影响因素。结果 HP感染与胃癌Lauren分型、肿瘤分化和淋巴结转移相关(P<0.05)。HP阳性胃癌患者中位生存时间为68.5个月,高于HP阴性患者的36.4个月(P=0.003)。接受根治性手术的HP阳性胃癌患者预后好于HP阴性患者(P=0.034)。亚组分析显示,HP阴性的肠型胃癌患者预后较HP阳性者差(P=0.006),但在弥漫型胃癌患者中未发现HP阴性和阳性者之间有差异(P=0.922)。结论 HP感染不是胃癌预后的独立影响因素。HP阳性感染状态的肠型胃癌患者临床预后可能较好。

Objective To observe the infection status of Helicobacter pylori（HP） in gastric cancer patients and to explore its relationship with the clinical characteristics of gastric cancer.Methods Paraffin sections of surgical specimens from 794 patients who underwent gastrectomy in Changzheng Hosptial or Changhai Hosptial were detected with the modified Giemsa staining to identify the status of HP infection.The association of HP infection status with the clinicopathological features was analyzed by Chi-square test.The relationship between HP infection status and prognosis of gastric patients was analyzed by Kaplan-Meier method and proportional hazard regression model.Results HP infection was significantly associated with Lauren classification,differentiation degree,and lymph-node metastases of gastric cancer（P0.05）.The median survival time of the HP positive patients（68.5 months） was significantly longer than that of HP negative patients（36.4 months）（P=0.003）.For patients undergoing curative surgeries,those with HP infection had a better prognosis compared with those without HP infection（P=0.034）.For patients with intestinal-type gastric cancer,those without HP infection had a poorer prognosis compared with those with HP infection（P=0.006）;there were no differences in patients with diffuse-type gastric cancer（P=0.922）.Conclusion Our results indicate that HP infection status is not an independent factor for prognosis of gastric cancer patients.HP positive patients with intestinal-type gastric cancer may have a better prognosis.