H. pylori infection is considered as the most important factors that lead to gastric cancer, however, the prognostic value of H. pylori infection in the prognosis of gastric cancer patients remains controversial and heterogeneous. If the prognostic role of H. pylori infection could be validated, it could provide clinically useful and microorganism-driven disease stratification. Therefore, we conducted this systematic review to evaluate whether H. pylori infection was significant predictor of overall or progression-free survival. Pooled analysis of overall survival including 7191 gastric cancer patients revealed a marginally significant prognostic value for H. pylori infection in GC patients. But the benefits of H. pylori infection of gastric cancer patients were not detected in Asian countries and United states. Gastric cancer patients with H. pylori infection in Asian countries and United States still need close follow-up and RCT studies are necessary to investigate the predictive role of H. pylori in these areas.

The prognostic value of Helicobacter pylori (H. pylori) infection in gastric cancer patients has been investigated over many years; however, the results remain inconclusive. Thus, we performed a comprehensive review of currently available evidence via a systemic meta-analysis to evaluate the effects of H. pylori infection on the prognosis of gastric cancer patients.

Studies that evaluated the prognostic value of H. pylori infection in gastric cancer were extracted in March 2016 by searching PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. We obtained or calculated hazard ratios (HRs) and the associated 95% confidence intervals (CIs) from the identified studies, and conducted random-effects model analyses of overall survival and progression-free survival. Twenty-four studies with a cumulative sample size of 7191 patients were included in our analysis.

Our meta-analysis revealed that H. pylori infection is an indicator of improved overall survival in gastric cancer patients (HR, 0.79; 95% CI, 0.64–0.99); however, this was only true for European patients. The benefits of H. pylori infection were not detected in Asian gastric cancer patients (HR, 1.01; 95% CI, 0.91–1.12) or those in the United States (HR, 0.88; 95% CI, 0.73–1.05). Subgroup analyses revealed that the prognostic significance of H. pylori infection differed with respect to the year of study publication, number of patients, H. pylori detection method, tumor stage, H. pylori-positive rate, and risk of bias. The prognostic value of H. pylori infection on progression-free survival was unclear (HR, 0.84; 95% CI, 0.70–1.01).

These data provide limited, moderate-quality evidence that H. pylori infection is an indicator of good prognosis in European gastric cancer patients. However, this is not necessarily true for other populations.