A systematic review and meta-analysis on the relative and attributable risk of Helicobacter pylori infection and cardia and non-cardia gastric cancer

ABSTRACT

Introduction

This study aimed to update the association between Helicobacter pylori (H. pylori) infection and gastric cancer (GC).

Methods

We searched PubMed, Embase, and Cochrane Library from 1990 to December 2021 to identify prospective studies. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were summarized to validate the relationship between H. pylori infection and GC.

Results

Including 27 studies, findings indicated a strong link between H. pylori and non-cardia gastric cancer (NCGC) in both Europe/North America (OR=5.37, 95%CI:4.39–6.57) and Asia (OR = 2.50, 95%CI:1.89–3.32), and a positive association with cardia gastric cancer (CGC) in Asia (OR = 1.74, 95%CI:1.38–2.19), but an inverse association in European/American populations (OR = 0.64, 95%CI: 0.51 to 0.79). Furthermore, the strength of association was greater in studies that detected H. pylori by immunoblotting versus ELISA, and also in studies testing for H. pylori detection further back in time prior to cancer diagnosis (Ptrend<0.05). Approximately 79% of NCGC in Asia and 87% in Europe/North America, along with 62% of CGC in Asia, could be attributable to H. pylori infection.

Conclusions

The meta-analysis supports the significant attributable risk of H. pylori infection for GC and underscores the potential impact of targeting H. pylori in GC prevention programs.

PROSPERO Registration

CRD42021274120

KEYWORDS:

• Gastric cancer
• Helicobacter pylori
• Meta-analysis
• Prospective study
• Population attributable fraction

Abbreviations

CGC	=	cardia gastric cancer
CI	=	confidence interval
ELISA	=	enzyme-linked immunosorbent assay
GC	=	gastric cancer
GERD	=	gastroesophageal reflux disease
HP	=	Helicobacter pylori
HR	=	hazard ratio
NCGC	=	non-cardia gastric cancer
NOS	=	Newcastle – Ottawa Scale
OR	=	odds ratio
PAF	=	population-attributable fraction
RR	=	relative risk

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Disclaimer

GM Clifford is an employee of the International Agency for Research on Cancer/World Health Organization. The views expressed in this paper are the responsibility of the authors and do not necessarily represent the views of the International Agency for Research on Cancer/World Health Organization.

Author contributions

Conceptualization, Shaoming Wang, Wenqiang Wei; Data Collection, Jianhua Gu, Feifan He, Minjuan, Li, Zhiyuan Fan, Jiachen, Zhou; Methodology, Shaoming Wang, Jianhua Gu; Supervision, Wenqiang Wei, Xinqing Li; Writing – original draft, Jianhua Gu, Feifan He; Writing – review & editing, Shaoming Wang, Gary M Clifford. All authors have read and agreed to the published version of the manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737159.2023.2277377

Additional information

Funding

This work was funded by grants from the Beijing Nova Program [No. Z201100006820069], National Key R&D Program of China [grant number: 2016YFC0901400, 2016YFC0901404, 2018YFC1311706], the National Natural Science Fund [grant number: 81573224], the CAMS Innovation Fund for Medical Sciences [grant number: 2021-I2M-1-023].