Non-Cardia and Cardia Gastric Cancer During COVID-19: Helicobacter pylori Association and Shifts in Cancer Staging

Aims Gastric cancer (GC) remains a significant global health challenge as the third leading cause of cancer-related mortality worldwide. This study aimed to assess the impact of the COVID-19 pandemic on gastric cancer outcomes in Western Romania by analysing cancer staging trends, clinical presentations, and pathological characteristics across three distinct periods: pre-pandemic (March 2018 – February 2020), pandemic (March 2020 – February 2022), and post-pandemic (March 2022 – February 2024). We also investigated the association between Helicobacter pylori (H. pylori) infection and other risk factors in GC patients to clarify its potential role in disease presentation and severity.

Methods A retrospective analysis was conducted on medical records from a cohort of 121 patients diagnosed with GC in a tertiary centre in Western Romania. Among these patients, 100 had non-cardia gastric cancer (NCGC), and 21 had cardia gastric cancer (CGC). Key data collected included demographic information, presenting clinical symptoms, histopathological findings, cancer staging using TNM classification, H. pylori infection status, and other risk factors. Additionally, patients’ upper gastrointestinal (GI) bleeding risk was evaluated in relation to antiplatelet and anticoagulant therapy.

Results In the post-pandemic period, a marked increase in advanced-stage cancer (Stages III and IVB) presentations was observed, indicating potential delays in diagnosis. Helicobacter pylori infection was more prevalent among NCGC patients, with 74% testing positive, compared to 47.62% of CGC patients. Patients on antiplatelet or anticoagulant therapy had a higher incidence of upper GI bleeding (0.7%) compared to those not receiving these therapies (0.45%). A weak positive correlation (r=0.28, p=0.0018) suggested a moderate association between antiplatelet/anticoagulant therapy and increased bleeding risk.

Conclusions This study highlights the pandemic’s impact on delayed GC diagnosis, which contributed to more advanced stages at presentation post-pandemic. Helicobacter pylori infection emerged as a significant risk factor for both cardia and non-cardia gastric cancer, with a notably higher prevalence in NCGC. These findings underline the importance of H. pylori screening and early diagnosis, particularly in NCGC patients, to reduce the risk of progression to advanced stages. Additionally, the increased bleeding risk in patients receiving antiplatelet or anticoagulant therapies highlights the need for careful management of these treatments in gastric cancer patients to prevent complications. Overall, our results emphasize the need for improved screening protocols and continuity of care for gastric cancer.

Publication History

Article published online:
27 March 2025