Cancer high-risk subjects identified by serum pepsinogen tests: outcomes after 10-year follow-up in asymptomatic middle-aged males.

Abstract

BACKGROUND:

Gastric cancer screening using the pepsinogen filter test is receiving wide recognition in Japan owing to convenience, freedom from discomfort or risk, efficiency, and economy. Because the long-term outcomes of cancer development in extensive atrophic gastritis detected by pepsinogen test are unclear, test-positive and test-negative subjects were investigated in a longitudinal cohort study.

METHODS:

Subjects comprised 5,209 middle-aged men with measured serum pepsinogen levels who were followed for 10 years. Cancer development based on "atrophy-positive" and "atrophy-negative" criteria used for cancer screening was investigated.

RESULTS:

During the study, 63 cases of cancer developed in the cohort, representing an incidence rate of 125 per 100,000 person-years. Pepsinogen test screening using the most widely used atrophy-positive criterion (pepsinogen I, < or =70 ng/mL; pepsinogen I/II ratio, < or =3.0) displayed 58.7% sensitivity, 73.4% specificity, and 2.6% positive predictive value. Cancer incidence rate was 276 per 100,000 person-years for the atrophy-positive group and 70 per 100,000 person-years for the atrophy-negative group. Incidence rate was higher in groups fulfilling stricter positive criteria detecting more extensive atrophy, reaching 424 per 100,000 person-years. In addition, 9.2% of atrophy-negative subjects with pepsinogen I of >70 ng/mL and pepsinogen I/II ratio of < or =3.0 (reflecting putative inflammation-based high pepsinogen II level) are at high risk for cancer, particularly diffuse-type cancer, with a cancer incidence rate comparable with atrophy-positive subjects (216 per 100,000 person-years).

CONCLUSION:

Atrophy-positive subjects by pepsinogen filter test, particularly those fulfilling stricter criteria, and atrophy-negative subjects with low pepsinogen I/II ratio reflecting putative extensive active inflammation constitute populations at high risk for gastric cancer, requiring thorough endoscopic examination.

• Authors: Kimihiko Yanaoka, Masashi Oka, Chizu Mukoubayashi, Noriko Yoshimura, Shotaro Enomoto, Mikitaka Iguchi, Hirohito Magari, Hirotoshi Utsunomiya, Hideyuki Tamai, Kenji Arii, Hiroshi Ohata, Mitsuhiro Fujishiro, Tatsuya Takeshita, Osamu Mohara, Masao Ichinose
• Journal: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology (Cancer Epidemiol Biomarkers Prev) Vol. 17 Issue 4 Pg. 838-45 (Apr 2008) ISSN: 1055-9965 [Print] United States
• PMID: 18398025 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers, Tumor
• Pepsinogen A

Topics

• Adult
• Atrophy (classification)
• Biomarkers, Tumor
• Follow-Up Studies
• Humans
• Incidence
• Japan (epidemiology)
• Male
• Mass Screening (methods, statistics & numerical data)
• Middle Aged
• Pepsinogen A (blood)
• Proportional Hazards Models
• Risk Factors
• Stomach Neoplasms (blood, epidemiology, pathology)