Association between Helicobacter pylori Infection and the types of Tumor Markers among Yemeni Gastric Cancer Patients: A Case-Control Study

Association between Helicobacter pylori Infection and the types of Tumor Markers among Yemeni Gastric Cancer Patients: A Case-Control Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association between Helicobacter pylori Infection and the types of Tumor Markers among Yemeni Gastric Cancer Patients: A Case-Control Study Gamil Taher Abdulmughni, Afeef S. Al-Nabhi, Amal A. Al-Sheibani, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6180249/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Helicobacter pylori (H. pylori) infection is a significant risk factor for gastric cancer, particularly in developing countries like Yemen, where the prevalence is high. This study aims to investigate the relationship between H. pylori infection and types of tumor markers (CEA and CA19-9) among Yemeni gastric cancer patients, comparing the frequency of these markers in patients with and without H. pylori infection. Methods A case-control study was conducted in Sana’a, Yemen, between January 2022 and December 2023. A total of 170 gastric cancer patients were enrolled, divided into two groups: 85 patients with H. pylori infection (cases) and 85 without (controls). Serum levels of CEA and CA19-9 were measured using enzyme-linked immunosorbent assay (ELISA). Results The frequency of CEA and CA19-9 was measured in both groups. The median CEA levels were 7.05 ng/mL in H. pylori positive group and 7.14 ng/mL in negative group. The median CA19-9 levels were 33 U/mL in H. pylori positive group and 32 U/mL in negative group. No significant differences were found in the serum levels of CEA (p = 0.44) or CA19-9 (p = 0.94) between the two groups. However, a significant association was observed between H. pylori infection and gastric cancer site in cardia and fundus regions (p = 0.047). Conclusion This study found no significant association between H. pylori infection and types of tumor markers (CEA and CA19-9) among Yemeni gastric cancer patients. However, the significant association between H. pylori infection and site of gastric cancer in cardia and fundus regions needs further investigations to reveal the associated mechanisms. Helicobacter pylori gastric cancer tumor markers Yemen Background Gastric cancer continues to pose a serious global health challenge, ranking as the fifth most common cancer and the third leading cause of cancer-related deaths worldwide [1]. Among the various risk factors, Helicobacter pylori ( H. pylori ) infection stands out as one of the most significant, having been classified as a Group 1 carcinogen by the International Agency for Research on Cancer ( 1 ). The prevalence of H. pylori infection varies across different regions, with developing countries experiencing higher rates due to issues such as inadequate sanitation and overcrowded living conditions ( 2 , 3 ) . In Yemen, the prevalence of H. pylori infection is particularly high, with studies suggesting that around 70% of the population is affected. This widespread occurrence highlights the significant burden of H. pylori in the region ( 4 – 6 ). While the role of H. pylori in the development of gastric cancer is well established, the relationship between the infection and specific types of tumor markers remains an area of ongoing research. Some studies have indicated that tumor markers like carcinoembryonic antigen (CEA) and carbohydrate antigen 19 − 9 (CA19-9) may be linked to H. pylori infection, possibly serving as indicators of gastric cancer risk ( 7 – 11 ). However, the prevalence of specific types of tumor markers in patients with and without H. pylori infection has not been thoroughly examined. H. pylori has multiple virulence factors (e.g. type IV secretion system and the CagA toxin) which may help H. pylori infection to progress to gastric carcinoma ( 12 , 13 ). Studies reported serum CEA to have excellent diagnostic efficacy in gastric cancer and other gastrointestinal tumors ( 14 ). CA724 showed no diagnostic value in gastrointestinal tumors ( 15 ). Therefore, this study aims to investigate the link between H. pylori infection and the types of expressed tumor markers (CEA and CA19-9) among Yemeni patients with gastric cancer, which may enhance our understanding of the disease and allow early detection and management of the disease in regions with a high prevalence of H. pylori . Methods Study design and population This case-control study was conducted in Sana’a, Yemen, between January 2022 and December 2023. The study involved 170 patients diagnosed with gastric cancer. Patients were divided into two groups: 85 gastric cancer patients infected with H. pylori (case group) and 85 gastric cancer patients not infected with H. pylori (control group). The inclusion criteria for participants were a confirmed diagnosis of gastric cancer by computed tomography (CT) scan and laboratory testing for H. pylori infection using the stool antigen test. Exclusion criteria included patients with a history of gastric surgery, other malignancies, or those who had received antibiotic treatment for H. pylori eradication in the last six months. Data collection Demographic and clinical data were collected using a structured questionnaire developed specifically for this study. It was administered through face-to-face interviews and medical record reviews. Information collected included age, gender, socioeconomic status, education level, smoking status, dietary habits, and family history of gastric cancer. The full questionnaire is available as a supplementary file (Supplementary Material 1). Laboratory tests H. pylori infection was determined using a stool antigen test (Abon Biopharm, Hangzhou Co. Ltd, China). Blood samples were collected from all participants, centrifuged to obtain serum, and stored at -20°C until analysis. Tumor markers, carcinoembryonic antigen (CEA) and carbohydrate antigen 19 − 9 (CA19-9), were measured using enzyme-linked immunosorbent assay (ELISA) kits according to the manufacturer’s instructions (Elecsys, Roche Company, Germany). The levels of these tumor markers were analyzed to determine their frequency in both the H. pylori positive and negative groups. Statistical Analysis Data were analyzed using IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation (SD) and compared using the Student's t-test or Mann-Whitney U test, depending on the distribution. Categorical variables, including the types of tumor markers, were expressed as frequencies and percentages, and compared using the chi-square test or Fisher’s exact test when appropriate. The association between H. pylori infection and the types of tumor markers (CEA and CA19-9) was assessed using logistic regression analysis, adjusting for potential confounders such as age, gender, and socioeconomic status. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. A P -value of < 0.05 was considered statistically significant. Results Demographic Characteristics of Gastric Cancer Patients The demographic characteristics are summarized in Table 1 . The mean age of participants was 56.05 ± 13.145 years, with a majority (62.4%) in the 30–60 age group. There were no statistically significant differences between the groups in terms of age, gender, socioeconomic status, or education level ( P > 0.05 for all variables). Table 1 Demographic Characteristics of Gastric Cancer Patients in Sana'a, Yemen (2022–2023) Characteristic Cases (H. pylori positive) Controls (H. pylori negative) Total P -value Age groups (years) ≤ 30 3 (3.5%) 2 (2.4%) 5 (2.9%) 0.20 30–60 58 (68.2%) 48 (56.5%) 106 (62.4%) ≥ 61 24 (28.2%) 35 (41.2%) 59 (34.7%) Mean ± STD 54.68 ± 13.101 57.41 ± 13.124 56.05 ± 13.145 Gender Males 60 (70.6%) 63 (74.1%) 123 (72.4%) 0.61 Females 25 (29.4%) 22 (25.9%) 47 (27.6%) Socioeconomic Status Low 56 (65.9%) 57 (67.1%) 113 (66.5%) 0.84 Moderate 27 (31.8%) 27 (31.8%) 54 (31.8%) High 2 (2.4%) 1 (1.2%) 3 (1.8%) Education Level Illiterate 40 (47.1%) 35 (41.2%) 75 (44.1%) 0.65 Primary 23 (27.1%) 30 (35.3%) 53 (31.2%) Moderate 18 (21.2%) 15 (17.6%) 33 (19.4%) High 4 (4.7%) 5 (5.9%) 9 (5.3%) Total 85 (100%) 85 (100%) 170 (100%) Association of H. pylori Infection with Tumor Marker Types The analysis of tumor marker types (CEA and CA19-9) was conducted in both groups. The median CEA levels were 7.05 ng/mL (range: 0.18–529) in the case group and 7.14 ng/mL (range: 0.18–3019) in the control group. The median CA19-9 levels were 33 U/mL (range: 0.3-29852) in the case group and 32 U/mL (range: 0.65–513) in the control group. However, no significant differences were observed in the prevalence or types of tumor markers between the two groups ( P = 0.44 for CEA and P = 0.94 for CA19-9), as shown in Table 2 . Table 2 Association of H. pylori Infection with Tumor Marker Types (CEA and CA19-9) in Gastric Cancer Patients in Sana'a, Yemen (2022–2023) Tumor marker Cases (H. pylori +) Controls (H. pylori -) Mann-Whitney P -value CEA 7.05 (0.18–529) 7.14 (0.18–3019) 3364 0.44 CA19-9 33 (0.3-29852) 32 (0.65–513) 3590 0.94 Values are presented as Median (range), CEA = Carcinoembryonic Antigen, CA19-9 = Carbohydrate Antigen 19 − 9. Risk Factors for H. pylori Infection The analysis of potential risk factors for H. pylori infection among gastric cancer patients is presented in Table 3 . There were no statistically significant associations between H. pylori infection and gender ( P = 0.61), age group ( P = 0.20), socioeconomic status ( P = 0.84), or education level ( P = 0.65). Additionally, factors such as living in crowded homes, having a family member with H. pylori infection, hand hygiene practices, eating from restaurants, and smoking were not significantly associated with H. pylori infection ( P > 0.05 for all). Table 3 Risk factors for getting H. pylori infection among in Gastric Cancer Patients in Sana'a, Yemen (2022–2023) Risk Factor Cases (H. pylori +) Controls (H. pylori -) OR CI (95%) χ2 P -value Gender (Male) 60 (70.6%) 63 (74.1%) 0.84 0.43–1.64 0.27 0.61 Age group (31–60 years) 58 (68.2%) 48 (56.5%) - - 3.19 0.20 Low socioeconomic status 56 (65.9%) 57 (67.1%) - - 0.34 0.84 Illiterate 40 (47.1%) 35 (41.2%) - - 1.64 0.65 Living in crowded home 67 (78.8%) 64 (75.3%) 0.82 0.40–1.68 0.3 0.58 Family member with H. pylori 38 (44.7%) 33 (38.8%) - - 5.22 0.07 Washing hands before eating 80 (94.1%) 77 (90.6%) - - 0.79 0.67 Eating from restaurants 68 (80%) 66 (77.6%) 0.87 0.42–1.81 0.14 0.71 Smoking 58 (68.2%) 55 (64.7%) 0.85 0.45–1.62 0.24 0.63 Association of H. pylori Infection with the Site of Gastric Cancer The association between H. pylori infection and the site of gastric cancer is summarized in Table 4 . A significant association was observed between H. pylori infection and cancer in the cardia and fundus region ( P = 0.047). However, no significant associations were found between H. pylori infection and other cancer sites such as the diffuse, body and antrum, body, antrum, or other locations ( P > 0.05 for all). Table 4 Association of H. pylori with the site of cancer in Gastric Cancer Patients in Sana'a, Yemen (2022–2023) Site of Cancer H. pylori Positive H. pylori Negative Total Chi-square (χ2) P -value Cardia 15 (17.6%) 23 (27.1%) 38 (22.4%) 1.68 0.194 Diffuse 17 (20%) 10 (11.8%) 27 (15.9%) 1.81 0.178 Body and Antrum 11 (6.5%) 7 (4.1%) 18 (10.6%) 0.89 0.346 Body 9 (10.6%) 9 (10.6%) 18 (10.6%) 0.00 1.000 Antrum 7 (8.2%) 10 (11.8%) 17 (10%) 0.53 0.467 Cardia and Fundus 11 (12.9%) 3 (3.5%) 14 (8.2%) 4.57 0.047* Cardia and Body 6 (7.1%) 6 (7.1%) 12 (7.1%) 0.00 1.000 Fundus and body 4(4.7%) 7(8.2%) 11(6.5%) 0.8 0.5 Fundus 1(1.2%) 7(8.2%) 8(4.7%) 3.3 0.06 Cardia and antrum 1(1.2%) 0(0%) 1(0.6%) 1.0 1 Cardia, fundus and body 2(2.4%) 1(1.2%) 3(1.8%) 0.3 1 Cardia, fundus and antrum 1(1.2%) 2(2.4%) 3(1.8%) 0.3 1 Total 85 (100%) 85 (100%) 170 (100%) *Fisher’s Exact test Discussion Although several studies reported an association between tumor markers (CEA and CA19-9) and H. pylori infection ( 16 , 17 ), the results of this study indicate that H. pylori infection is not significantly associated with the types of tumor markers, CEA and CA19-9, in Yemeni gastric cancer patients. Absence of a significant association between H. pylori infection and tumor marker expression among gastric cancer patients may be attributed to the heterogeneity of gastric cancer, including morphological subtypes (intestinal vs. diffuse) and molecular subtypes (MSI, EBV, TP53 mutation) ( 18 – 20 ). It could be also attributed to presence of different strains of H. pylori that have varying levels of pathogenicity due to genetic diversity (e.g., cagA and vacA gene variations). Strain differences may influence their role in carcinogenesis and their association with specific tumor markers ( 21 – 23 ). Unlike other studies from the West which reported H. pylori to be commonly associated with tumors located distally (antrum/pylorus), this study found H. pylori to be significantly associated with cardia and funds tumors ( 24 – 26 ). On the other hand, our result is in agreement with studies from the Asia which reported H. pylori to be associated with cardia gastric cancer, suggesting presence of other factors such as environmental and habitual factors and lifestyle ( 27 – 29 ). Moreover, the absence of significant associations between H. pylori infection and demographic factors, such as age, gender, socioeconomic status, and education level, is consistent with some previous studies, although others have reported contrasting results ( 30 – 32 ). In Yemen, the high prevalence of H. pylori infection, regardless of these demographic factors, may be due to widespread risk factors such as poor sanitation and inadequate hygiene practices ( 4 , 6 ). Due to the ongoing humanitarian crisis and collapsing healthcare infrastructure in our country, most patients present with advanced gastric cancer, leading to a lack of reliable Tumor-Node-Metastasis (TNM) staging data and thus limiting our ability to account for tumor stage as a potential confounding factor. Conclusion and recommendation Lack of association between H. pylori and type of tumor markers implies that the mechanisms driving tumor markers’ expression in stomach cancer may be H. pylori independent pathways, suggesting that once cancer has developed, the tumor's biological behavior and marker expression are likely influenced by factors beyond the initial infectious trigger. Further studies on the association between H. pylori infection and type of tumor markers based on the morphological and molecular gastric cancer subtypes as well as H. pylori strains are recommended. Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of the Faculty of Medicine and Health Sciences, Sana’a University (Approval No: FMHS/2022/019). Written informed consent was obtained from all participants before enrollment in the study. Participants were assured of the confidentiality of their information and their right to withdraw from the study at any time without any consequences. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials The data that support the findings of this study are available. Anyone interested can get upon reasonable request from corresponding author. Competing interests The authors declare that they have no competing interests. Funding The authors didn’t take any fund for this study Authors’ contributions AMO and AA wrote the main text, ASA and GTA perform the practical part, NMA and KHJ participated in revision. All authors participated in revision and corrections of final drafts. Acknowledgements Authors are grateful to all patients who participated in this study References Schistosomes I. liver flukes and Helicobacter pylori. IARC Monogr Eval Carcinog Risks Hum. 1994;61:1–241. Hooi JKY, Lai WY, Ng WK, Suen MMY, Underwood FE, Tanyingoh D, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153(2):420–9. Li Y, Choi H, Leung K, Jiang F, Graham DY, Leung WK. Global prevalence of Helicobacter pylori infection between 1980 and 2022: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(6):553–64. Alsulaimany FAS, Awan ZA, Almohamady AM, Koumu MI, Yaghmoor BE, Elhady SS, et al. 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Environmental and Genetic Risk Factors for Gastric Cancer. Gastrointestinal Malignancies. 2024;1–17. Additional Declarations No competing interests reported. Supplementary Files questionnaire.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6180249","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":445348432,"identity":"fe859a50-7caf-4e7c-867a-084713de378e","order_by":0,"name":"Gamil Taher Abdulmughni","email":"","orcid":"","institution":"University of 21","correspondingAuthor":false,"prefix":"","firstName":"Gamil","middleName":"Taher","lastName":"Abdulmughni","suffix":""},{"id":445348434,"identity":"9c98e24b-04f4-4d5c-bacd-55f21c0557d8","order_by":1,"name":"Afeef S. 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Among the various risk factors, \u003cem\u003eHelicobacter pylori\u003c/em\u003e (\u003cem\u003eH. pylori\u003c/em\u003e) infection stands out as one of the most significant, having been classified as a Group 1 carcinogen by the International Agency for Research on Cancer (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The prevalence of \u003cem\u003eH. pylori\u003c/em\u003e infection varies across different regions, with developing countries experiencing higher rates due to issues such as inadequate sanitation and overcrowded living conditions (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) .\u003c/p\u003e \u003cp\u003eIn Yemen, the prevalence of \u003cem\u003eH. pylori\u003c/em\u003e infection is particularly high, with studies suggesting that around 70% of the population is affected. This widespread occurrence highlights the significant burden of \u003cem\u003eH. pylori\u003c/em\u003e in the region (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). While the role of \u003cem\u003eH. pylori\u003c/em\u003e in the development of gastric cancer is well established, the relationship between the infection and specific types of tumor markers remains an area of ongoing research. Some studies have indicated that tumor markers like carcinoembryonic antigen (CEA) and carbohydrate antigen 19\u0026thinsp;\u0026minus;\u0026thinsp;9 (CA19-9) may be linked to \u003cem\u003eH. pylori\u003c/em\u003e infection, possibly serving as indicators of gastric cancer risk (\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, the prevalence of specific types of tumor markers in patients with and without \u003cem\u003eH. pylori\u003c/em\u003e infection has not been thoroughly examined.\u003c/p\u003e \u003cp\u003e \u003cem\u003eH. pylori\u003c/em\u003e has multiple virulence factors (e.g. type IV secretion system and the CagA toxin) which may help \u003cem\u003eH. pylori\u003c/em\u003e infection to progress to gastric carcinoma (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Studies reported serum CEA to have excellent diagnostic efficacy in gastric cancer and other gastrointestinal tumors (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). CA724 showed no diagnostic value in gastrointestinal tumors (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Therefore, this study aims to investigate the link between \u003cem\u003eH. pylori\u003c/em\u003e infection and the types of expressed tumor markers (CEA and CA19-9) among Yemeni patients with gastric cancer, which may enhance our understanding of the disease and allow early detection and management of the disease in regions with a high prevalence of \u003cem\u003eH. pylori\u003c/em\u003e.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and population\u003c/h2\u003e \u003cp\u003eThis case-control study was conducted in Sana\u0026rsquo;a, Yemen, between January 2022 and December 2023. The study involved 170 patients diagnosed with gastric cancer. Patients were divided into two groups: 85 gastric cancer patients infected with \u003cem\u003eH. pylori\u003c/em\u003e (case group) and 85 gastric cancer patients not infected with \u003cem\u003eH. pylori\u003c/em\u003e (control group). The inclusion criteria for participants were a confirmed diagnosis of gastric cancer by computed tomography (CT) scan and laboratory testing for \u003cem\u003eH. pylori\u003c/em\u003e infection using the stool antigen test. Exclusion criteria included patients with a history of gastric surgery, other malignancies, or those who had received antibiotic treatment for \u003cem\u003eH. pylori\u003c/em\u003e eradication in the last six months.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eDemographic and clinical data were collected using a structured questionnaire developed specifically for this study. It was administered through face-to-face interviews and medical record reviews. Information collected included age, gender, socioeconomic status, education level, smoking status, dietary habits, and family history of gastric cancer. The full questionnaire is available as a supplementary file (Supplementary Material 1).\u003c/p\u003e\n\u003ch3\u003eLaboratory tests\u003c/h3\u003e\n\u003cp\u003e \u003cem\u003eH. pylori\u003c/em\u003e infection was determined using a stool antigen test (Abon Biopharm, Hangzhou Co. Ltd, China). Blood samples were collected from all participants, centrifuged to obtain serum, and stored at -20\u0026deg;C until analysis. Tumor markers, carcinoembryonic antigen (CEA) and carbohydrate antigen 19\u0026thinsp;\u0026minus;\u0026thinsp;9 (CA19-9), were measured using enzyme-linked immunosorbent assay (ELISA) kits according to the manufacturer\u0026rsquo;s instructions (Elecsys, Roche Company, Germany). The levels of these tumor markers were analyzed to determine their frequency in both the \u003cem\u003eH. pylori\u003c/em\u003e positive and negative groups.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and compared using the Student's t-test or Mann-Whitney U test, depending on the distribution. Categorical variables, including the types of tumor markers, were expressed as frequencies and percentages, and compared using the chi-square test or Fisher\u0026rsquo;s exact test when appropriate. The association between \u003cem\u003eH. pylori\u003c/em\u003e infection and the types of tumor markers (CEA and CA19-9) was assessed using logistic regression analysis, adjusting for potential confounders such as age, gender, and socioeconomic status. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. A \u003cem\u003eP\u003c/em\u003e-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Characteristics of Gastric Cancer Patients\u003c/h2\u003e \u003cp\u003eThe demographic characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of participants was 56.05\u0026thinsp;\u0026plusmn;\u0026thinsp;13.145 years, with a majority (62.4%) in the 30\u0026ndash;60 age group. There were no statistically significant differences between the groups in terms of age, gender, socioeconomic status, or education level (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all variables).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics of Gastric Cancer Patients in Sana'a, Yemen (2022\u0026ndash;2023)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCases (H. pylori positive)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControls (H. pylori negative)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge groups (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (68.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (56.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106 (62.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (28.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (41.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (34.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;STD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.68\u0026thinsp;\u0026plusmn;\u0026thinsp;13.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.41\u0026thinsp;\u0026plusmn;\u0026thinsp;13.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.05\u0026thinsp;\u0026plusmn;\u0026thinsp;13.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (70.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (74.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e123 (72.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (29.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (27.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocioeconomic Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (65.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (67.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113 (66.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (47.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (41.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75 (44.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (27.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (31.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (21.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAssociation of\u003c/b\u003e \u003cb\u003eH. pylori\u003c/b\u003e \u003cb\u003eInfection with Tumor Marker Types\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe analysis of tumor marker types (CEA and CA19-9) was conducted in both groups. The median CEA levels were 7.05 ng/mL (range: 0.18\u0026ndash;529) in the case group and 7.14 ng/mL (range: 0.18\u0026ndash;3019) in the control group. The median CA19-9 levels were 33 U/mL (range: 0.3-29852) in the case group and 32 U/mL (range: 0.65\u0026ndash;513) in the control group. However, no significant differences were observed in the prevalence or types of tumor markers between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.44 for CEA and \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.94 for CA19-9), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of \u003cem\u003eH. pylori\u003c/em\u003e Infection with Tumor Marker Types (CEA and CA19-9) in Gastric Cancer Patients in Sana'a, Yemen (2022\u0026ndash;2023)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor marker\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCases (H. pylori +)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControls (H. pylori -)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMann-Whitney\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCEA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.05 (0.18\u0026ndash;529)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.14 (0.18\u0026ndash;3019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA19-9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (0.3-29852)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (0.65\u0026ndash;513)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eValues are presented as Median (range), CEA\u0026thinsp;=\u0026thinsp;Carcinoembryonic Antigen, CA19-9\u0026thinsp;=\u0026thinsp;Carbohydrate Antigen 19\u0026thinsp;\u0026minus;\u0026thinsp;9.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eRisk Factors for\u003c/b\u003e \u003cb\u003eH. pylori\u003c/b\u003e \u003cb\u003eInfection\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe analysis of potential risk factors for \u003cem\u003eH. pylori\u003c/em\u003e infection among gastric cancer patients is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. There were no statistically significant associations between \u003cem\u003eH. pylori\u003c/em\u003e infection and gender (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.61), age group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.20), socioeconomic status (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.84), or education level (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.65). Additionally, factors such as living in crowded homes, having a family member with \u003cem\u003eH. pylori\u003c/em\u003e infection, hand hygiene practices, eating from restaurants, and smoking were not significantly associated with \u003cem\u003eH. pylori\u003c/em\u003e infection (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRisk factors for getting H. pylori infection among in Gastric Cancer Patients in Sana'a, Yemen (2022\u0026ndash;2023)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCases (H. pylori +)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControls (H. pylori -)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCI (95%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (Male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (70.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63 (74.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.43\u0026ndash;1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group (31\u0026ndash;60 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (68.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (56.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow socioeconomic status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (65.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57 (67.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (47.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (41.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving in crowded home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (78.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64 (75.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.40\u0026ndash;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily member with H. pylori\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (44.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (38.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWashing hands before eating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (94.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77 (90.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEating from restaurants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (77.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.42\u0026ndash;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (68.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (64.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45\u0026ndash;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAssociation of\u003c/b\u003e \u003cb\u003eH. pylori\u003c/b\u003e \u003cb\u003eInfection with the Site of Gastric Cancer\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe association between \u003cem\u003eH. pylori\u003c/em\u003e infection and the site of gastric cancer is summarized in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. A significant association was observed between \u003cem\u003eH. pylori\u003c/em\u003e infection and cancer in the cardia and fundus region (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.047). However, no significant associations were found between \u003cem\u003eH. pylori\u003c/em\u003e infection and other cancer sites such as the diffuse, body and antrum, body, antrum, or other locations (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of H. pylori with the site of cancer in Gastric Cancer Patients in Sana'a, Yemen (2022\u0026ndash;2023)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSite of Cancer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eH. pylori Positive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eH. pylori Negative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChi-square (χ2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (27.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (22.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiffuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody and Antrum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.346\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntrum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardia and Fundus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (12.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.047*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardia and Body\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFundus and body\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(4.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFundus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(4.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardia and antrum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardia, fundus and body\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardia, fundus and antrum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Fisher\u0026rsquo;s Exact test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlthough several studies reported an association between tumor markers (CEA and CA19-9) and \u003cem\u003eH. pylori\u003c/em\u003e infection (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), the results of this study indicate that \u003cem\u003eH. pylori\u003c/em\u003e infection is not significantly associated with the types of tumor markers, CEA and CA19-9, in Yemeni gastric cancer patients. Absence of a significant association between \u003cem\u003eH. pylori\u003c/em\u003e infection and tumor marker expression among gastric cancer patients may be attributed to the heterogeneity of gastric cancer, including morphological subtypes (intestinal vs. diffuse) and molecular subtypes (MSI, EBV, TP53 mutation) (\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). It could be also attributed to presence of different strains of \u003cem\u003eH. pylori\u003c/em\u003e that have varying levels of pathogenicity due to genetic diversity (e.g., \u003cem\u003ecagA\u003c/em\u003e and \u003cem\u003evacA\u003c/em\u003e gene variations). Strain differences may influence their role in carcinogenesis and their association with specific tumor markers (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUnlike other studies from the West which reported \u003cem\u003eH. pylori\u003c/em\u003e to be commonly associated with tumors located distally (antrum/pylorus), this study found \u003cem\u003eH. pylori\u003c/em\u003e to be significantly associated with cardia and funds tumors (\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). On the other hand, our result is in agreement with studies from the Asia which reported \u003cem\u003eH. pylori\u003c/em\u003e to be associated with cardia gastric cancer, suggesting presence of other factors such as environmental and habitual factors and lifestyle (\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMoreover, the absence of significant associations between \u003cem\u003eH. pylori\u003c/em\u003e infection and demographic factors, such as age, gender, socioeconomic status, and education level, is consistent with some previous studies, although others have reported contrasting results (\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In Yemen, the high prevalence of \u003cem\u003eH. pylori\u003c/em\u003e infection, regardless of these demographic factors, may be due to widespread risk factors such as poor sanitation and inadequate hygiene practices (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDue to the ongoing humanitarian crisis and collapsing healthcare infrastructure in our country, most patients present with advanced gastric cancer, leading to a lack of reliable Tumor-Node-Metastasis (TNM) staging data and thus limiting our ability to account for tumor stage as a potential confounding factor.\u003c/p\u003e"},{"header":"Conclusion and recommendation","content":"\u003cp\u003eLack of association between \u003cem\u003eH. pylori\u003c/em\u003e and type of tumor markers implies that the mechanisms driving tumor markers\u0026rsquo; expression in stomach cancer may be \u003cem\u003eH. pylori\u003c/em\u003e independent pathways, suggesting that once cancer has developed, the tumor's biological behavior and marker expression are likely influenced by factors beyond the initial infectious trigger. Further studies on the association between \u003cem\u003eH. pylori\u003c/em\u003e infection and type of tumor markers based on the morphological and molecular gastric cancer subtypes as well as \u003cem\u003eH. pylori\u003c/em\u003e strains are recommended.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of the Faculty of Medicine and Health Sciences, Sana\u0026rsquo;a University (Approval No: FMHS/2022/019). Written informed consent was obtained from all participants before enrollment in the study. Participants were assured of the confidentiality of their information and their right to withdraw from the study at any time without any consequences. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available. Anyone interested can get upon reasonable request from corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors didn\u0026rsquo;t take any fund for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAMO and AA wrote the main text, ASA and GTA perform the practical part, NMA and KHJ participated in revision. All authors participated in revision and corrections of final drafts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors are grateful to all patients who participated in this study\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSchistosomes I. liver flukes and Helicobacter pylori. IARC Monogr Eval Carcinog Risks Hum. 1994;61:1\u0026ndash;241. \u003c/li\u003e\n\u003cli\u003eHooi JKY, Lai WY, Ng WK, Suen MMY, Underwood FE, Tanyingoh D, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153(2):420\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eLi Y, Choi H, Leung K, Jiang F, Graham DY, Leung WK. Global prevalence of Helicobacter pylori infection between 1980 and 2022: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(6):553\u0026ndash;64. \u003c/li\u003e\n\u003cli\u003eAlsulaimany FAS, Awan ZA, Almohamady AM, Koumu MI, Yaghmoor BE, Elhady SS, et al. Prevalence of Helicobacter pylori infection and diagnostic methods in the Middle East and North Africa Region. Medicina (B Aires). 2020;56(4):169. \u003c/li\u003e\n\u003cli\u003eAl-Badaii F, Bajah K, Ahmed S, Al-Ameri H, Shumaila H, Abbas Z, et al. Prevalence of Helicobacter pylori infection and associated risk factors among schoolchildren at Dhamar City, Yemen. Int J Sci Res Biol Sci. 2021;8(6):16\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eAlmashhadany DA, Mayas SM, Mohammed HI, Hassan AA, Khan IUH. Population‐and Gender‐Based Investigation for Prevalence of Helicobacter pylori in Dhamar, Yemen. Can J Gastroenterol Hepatol. 2023;2023(1):3800810. \u003c/li\u003e\n\u003cli\u003eCorrea P, Piazuelo MB. Helicobacter pylori infection and gastric adenocarcinoma. US Gastroenterol Hepatol Rev. 2011;7(1):59. \u003c/li\u003e\n\u003cli\u003eHatakeyama M. Helicobacter pylori CagA and gastric cancer: a paradigm for hit-and-run carcinogenesis. Cell Host Microbe. 2014;15(3):306\u0026ndash;16. \u003c/li\u003e\n\u003cli\u003eSalvatori S, Marafini I, Laudisi F, Monteleone G, Stolfi C. Helicobacter pylori and gastric cancer: pathogenetic mechanisms. Int J Mol Sci. 2023;24(3):2895. \u003c/li\u003e\n\u003cli\u003eAlipour M. Molecular mechanism of Helicobacter pylori-induced gastric cancer. J Gastrointest Cancer. 2021;52:23\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eKim J, Wang TC. Helicobacter pylori and gastric cancer. Gastrointestinal Endoscopy Clinics. 2021;31(3):451\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003ePadda J, Khalid K, Cooper AC, Jean-Charles G. Association between Helicobacter pylori and gastric carcinoma. Cureus. 2021;13(5). \u003c/li\u003e\n\u003cli\u003eReyes VE. Helicobacter pylori and its role in gastric cancer. Microorganisms. 2023;11(5):1312. \u003c/li\u003e\n\u003cli\u003eWang R, Zuo CL, Zhang R, Zhu LM. Carcinoembryonic antigen, carbohydrate antigen 199 and carbohydrate antigen 724 in gastric cancer and their relationship with clinical prognosis. World J Gastrointest Oncol. 2023;15(8):1475. \u003c/li\u003e\n\u003cli\u003eCao H, Zhu L, Li L, Wang W, Niu X. Serum CA724 has no diagnostic value for gastrointestinal tumors. Clin Exp Med. 2023;23(6):2433\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eJing R, Cui M, Ju S, Pan S. The Changes and Clinical Significance of Preoperative and Postoperative Serum CEA and CA19-9 in Gastric Cancer. Clin Lab. 2020;86(4). \u003c/li\u003e\n\u003cli\u003eXu MY, Cao B, Chen Y, Musial N, Wang S, Yin J, et al. Association between Helicobacter pylori infection and tumor markers: an observational retrospective study. BMJ Open. 2018;8(8):e022374. \u003c/li\u003e\n\u003cli\u003eChia NY, Tan P. Molecular classification of gastric cancer. Annals of Oncology. 2016;27(5):763\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eYuen ST, Leung SY. Genomics study of gastric cancer and its molecular subtypes. Stem Cells, Pre-neoplasia, and Early Cancer of the Upper Gastrointestinal Tract. 2016;419\u0026ndash;39. \u003c/li\u003e\n\u003cli\u003eKim M, Seo AN. Molecular pathology of gastric cancer. J Gastric Cancer. 2022;22(4):273. \u003c/li\u003e\n\u003cli\u003eMarie MAM. Relationship between Helicobacter pylori virulence genes and clinical outcomes in Saudi patients. J Korean Med Sci. 2012;27(2):190\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eInagaki T, Nishiumi S, Ito Y, Yamakawa A, Yamazaki Y, Yoshida M, et al. Associations between cagA, vacA, and the clinical outcomes of Helicobacter pylori infections in Okinawa, Japan. Kobe Journal of Medical Sciences. 2017;63(2):E58. \u003c/li\u003e\n\u003cli\u003eNejati S, Karkhah A, Darvish H, Validi M, Ebrahimpour S, Nouri HR. Influence of Helicobacter pylori virulence factors CagA and VacA on pathogenesis of gastrointestinal disorders. Microb Pathog. 2018;117:43\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eMartin-de-Argila C, Boixeda D, Redondo C, Alvarez I, Gisbert JP, Plaza AG, et al. Relation between histologic subtypes and location of gastric cancer and Helicobacter pylori. Scand J Gastroenterol. 1997;32(4):303\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003ePark JB, Koo JS. Helicobacter pylori infection in gastric mucosa-associated lymphoid tissue lymphoma. World journal of gastroenterology: WJG. 2014;20(11):2751. \u003c/li\u003e\n\u003cli\u003eGroup H and CC. Gastric cancer and Helicobacter pylori: a combined analysis of 12 case control studies nested within prospective cohorts. Gut. 2001;49(3):347\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eHan Z, Liu J, Zhang W, Kong Q, Wan M, Lin M, et al. Cardia and non‐cardia gastric cancer risk associated with Helicobacter pylori in East Asia and the West: A systematic review, meta‐analysis, and estimation of population attributable fraction. Helicobacter. 2023;28(2):e12950. \u003c/li\u003e\n\u003cli\u003eYao P, Kartsonaki C, Butt J, Jeske R, De Martel C, Plummer M, et al. Helicobacter pylori multiplex serology and risk of non-cardia and cardia gastric cancer: a case-cohort study and meta-analysis. Int J Epidemiol. 2023;52(4):1197\u0026ndash;208. \u003c/li\u003e\n\u003cli\u003eKo KP. Risk factors of gastric cancer and lifestyle modification for prevention. J Gastric Cancer. 2024;24(1):99. \u003c/li\u003e\n\u003cli\u003ePeres S V, Silva DRM, Coimbra FJF, Fagundes MA, Auzier JJN, Pelosof AG, et al. Consumption of processed and ultra-processed foods by patients with stomach adenocarcinoma: a multicentric case\u0026ndash;control study in the Amazon and southeast regions of Brazil. Cancer Causes \u0026amp; Control. 2022;33(6):889\u0026ndash;98. \u003c/li\u003e\n\u003cli\u003eGonzalez‐Palacios S, Compa\u0026ntilde;‐Gabucio L, Torres‐Collado L, Oncina‐Canovas A, Garc\u0026iacute;a‐de‐la‐Hera M, Collatuzzo G, et al. The protective effect of dietary folate intake on gastric cancer is modified by alcohol consumption: A pooled analysis of the StoP Consortium. Int J Cancer. 2024; \u003c/li\u003e\n\u003cli\u003eShah D, Bentrem D. Environmental and Genetic Risk Factors for Gastric Cancer. Gastrointestinal Malignancies. 2024;1\u0026ndash;17. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Helicobacter pylori, gastric cancer, tumor markers, Yemen","lastPublishedDoi":"10.21203/rs.3.rs-6180249/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6180249/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e \u003cem\u003eHelicobacter pylori (H. pylori)\u003c/em\u003e infection is a significant risk factor for gastric cancer, particularly in developing countries like Yemen, where the prevalence is high. This study aims to investigate the relationship between \u003cem\u003eH. pylori\u003c/em\u003e infection and types of tumor markers (CEA and CA19-9) among Yemeni gastric cancer patients, comparing the frequency of these markers in patients with and without \u003cem\u003eH. pylori\u003c/em\u003e infection.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA case-control study was conducted in Sana\u0026rsquo;a, Yemen, between January 2022 and December 2023. A total of 170 gastric cancer patients were enrolled, divided into two groups: 85 patients with \u003cem\u003eH. pylori\u003c/em\u003e infection (cases) and 85 without (controls). Serum levels of CEA and CA19-9 were measured using enzyme-linked immunosorbent assay (ELISA).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe frequency of CEA and CA19-9 was measured in both groups. The median CEA levels were 7.05 ng/mL in \u003cem\u003eH. pylori\u003c/em\u003e positive group and 7.14 ng/mL in negative group. The median CA19-9 levels were 33 U/mL in \u003cem\u003eH. pylori\u003c/em\u003e positive group and 32 U/mL in negative group. No significant differences were found in the serum levels of CEA (p\u0026thinsp;=\u0026thinsp;0.44) or CA19-9 (p\u0026thinsp;=\u0026thinsp;0.94) between the two groups. However, a significant association was observed between \u003cem\u003eH. pylori\u003c/em\u003e infection and gastric cancer site in cardia and fundus regions (p\u0026thinsp;=\u0026thinsp;0.047).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study found no significant association between \u003cem\u003eH. pylori\u003c/em\u003e infection and types of tumor markers (CEA and CA19-9) among Yemeni gastric cancer patients. However, the significant association between \u003cem\u003eH. pylori\u003c/em\u003e infection and site of gastric cancer in cardia and fundus regions needs further investigations to reveal the associated mechanisms.\u003c/p\u003e","manuscriptTitle":"Association between Helicobacter pylori Infection and the types of Tumor Markers among Yemeni Gastric Cancer Patients: A Case-Control Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-22 08:06:09","doi":"10.21203/rs.3.rs-6180249/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"04e257e3-d473-4a5a-9b52-cf108e27c36a","owner":[],"postedDate":"April 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-22T14:38:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-22 08:06:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6180249","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6180249","identity":"rs-6180249","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}