Helicobacter pylori infection as a prognostic factor in gastric cancer: Impact of comorbidities on overall survival

Helicobacter pylori infection is a risk factor for gastric cancer, but its impact on prognosis remains underexplored in high-prevalence settings such as Brazil. This study aimed to estimate overall survival in patients with gastric adenocarcinoma and H. pylori infection and identify comorbidities associated with prognosis in a Brazilian multicenter cohort. This was a prospective multicenter cohort study in three Brazilian centers (North, Midwest, Southeast). Sociodemographic, clinical, and histopathological variables were analyzed among patients tested for H. pylori . Frequencies were compared via Pearson's chi-square test. The probability of overall survival was estimated via Kaplan‒Meier analysis, and associations with prognostic factors were assessed via Cox regression (stepwise forward, p < 0.20). H. pylori -positive patients had greater survival (65%) than H. pylori -negative patients did (51%), but the difference was not significant. Infection is associated with tumors in the body/antrum and initial stage. In the multiple model, stage III/IV disease and a Charlson Comorbidity Index score ≥ 3 were associated with increased mortality regardless of infection status. Among the negative patients, those with vascular disease had an increased risk of death (HR = 1.67; p = 0.05). Among positive patients, those with peptic ulcer (HR = 6.53; 95% CI 1.44–29.54; p = 0.01) and diabetes (HR = 3.81; 95% CI 0.99–14.70; p = 0.05) tended to have increased mortality. In this Brazilian multicenter cohort, H. pylori infection was associated with a worse prognosis in patients with gastric adenocarcinoma. Vascular disease increased mortality among negative patients, whereas peptic ulcer and diabetes tended to increase mortality among positive patients. Assessing comorbidities and H. pylori status should be considered in the prognosis and therapeutic management of these patients.