ABSTRACT
Objective:To investigate the value of serum gastrin-17 (G-17), pepsinogen (PG) I and II, and narrow-band imaging endoscopy in combination for identifying early gastric cancer.Methods:A total of 86 patients with suspected gastric cancer admitted to Zhoushan Hospital from January to September 2021 were included in this study. These patients underwent serum G-17, PG I, and PG II examination and narrow-band imaging endoscopy. PG I/PG II ratio (PGR) was calculated. Taking pathological results as a gold standard, the sensitivity, specificity, and accuracy of serum G-17, PG I, PG II, and narrow-band imaging endoscopy in combination for identifying early gastric cancer were calculated.Results:Serum G-17 level and PGR in the gastric cancer group were (20.14 ± 4.59) pmol/L and (20.21 ± 4.50) μg/L, respectively, which were significantly higher than (17.06 ± 4.05) pmol/L and (17.15 ± 4.08) μg/L in the atrophic gastritis group ( q = 4.12, 3.77, both P < 0.05) and (12.35 ± 3.31) pmol/L and (10.82 ± 5.26) μg/L in the non-atrophic gastritis group ( q = 9.34, 10.39, both P < 0.05). PG I and PGR in the gastric cancer group were (63.90 ± 14.41) μg/L and (3.17 ± 2.08), respectively, which were significantly lower than (79.34 ± 16.25) μg/L and (5.04 ± 3.61) in the atrophic gastritis group ( q = 5.33, 3.44, both P < 0.05) and (106.42 ± 20.18) μg/L and (9.22 ± 4.06) in the non-atrophic gastritis group ( q = 13.16, 9.97, both P < 0.05). Among the 86 patients included, gastric cancer was determined by biopsy in 43 patients. Pathological results showed that 37 patients had early gastric cancer and 6 patients had gastric cancer involving the muscle layer or serous layer. Narrow-band imaging endoscopy results showed that 83.78% (31/37) of patients had early gastric cancer. Serum G-17, PG, and narrow-band imaging endoscopy in combination showed that 91.89% (34/37) of patients had early gastric cancer. Taking pathological results as a gold standard, the sensitivity, specificity, positive predictive value, and negative predictive value of serum G-17 combined with PG for screening early gastric cancer were 72.97% (27/37), 77.55% (38/49), 71.05% (27/38), and 79.17% (38/48), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of narrow-band imaging endoscopy for screening early gastric cancer were 83.78% (31/37), 85.71% (42/49), 83.10% (31/38), and 87.50% (42/48). The sensitivity and specificity of serum G-17, PG, and narrow-band imaging endoscopy in combination for screening early gastric cancer were 91.89% (34/37) and 91.84% (45/49), respectively. Conclusion:Serum G-17, pepsinogen, and narrow-band imaging endoscopy in combination can improve the diagnostic accuracy of early gastric cancer and is an effective method for screening early gastric cancer.
ABSTRACT
Abstract Introduction: Costa Rica has among the highest mortality rates from gastric cancer in the world, largely due to late detection. It is therefore important that economically and logistically sustainable screening is implemented in order to detect risk of developing cancer. We have previously shown that low pepsinogen (PG) values and infection with Helicobacter pylori-CagA+ are associated with risk of gastric atrophy and cancer in Costa Rican populations. OBJECTIVES: To determine how markers for gastric cancer risk are distributed in an elderly population representative of Costa Rica in order to design a screening strategy. METHODS: The population studied consists of 2,652 participants in a nationally representative survey of ageing. Information concerning epidemiologic, demographic, nutritional and life style factors is available. Serum PG concentrations as well as H. pylori and CagA status were determined by serology. Possible associations were determined by regression analyses. RESULTS: Antibodies to H. pylori were present in 72% of the population and of those, 58% were CagA positive. Infection with H. pylori was associated with higher PGI concentrations (p=0.000) and infection with H. pylori-CagA. with lower PGI concentrations (p=0.025). Both showed association with lower PGI/PGII (p=0.006 and p=0.000). Higher age was associated with lower prevalence of H. pylori infection (OR=0.98; p=0.000) and CagA. (OR=0.98; p=0.000) but not with PG values. Regions with high risk of gastric cancer showed lower PGI (p=0.004) and PGI/PGII values (p=0.021) as well as higher prevalence of H. pylori infection (OR=1.39; p=0.013) but not CagA.. Using cut-off values of PGI<100 µg/L and PGI/PGII<2.0, 2.5 and 3.0, 7-15% of the population would be considered at risk. CONCLUSIONS: H. pylorialone is not a useful marker for risk of gastric cancer. Screening using serum pepsinogen concentrations and infection with H. pylori-CagA. is feasible in the general elderly population of Costa Rica but appropriate cut-off values have to be determined based on more clinical data and follow up capacity.
Resumen Introducción: Costa Rica tiene una de las tasas de mortalidad por cáncer gástrico más altas del mundo, en gran parte debido a la detección tardía. Por lo tanto, es importante que se implemente un tamizaje económico y logísticamente sostenible para detectar el riesgo de desarrollar cáncer. En estudios anteriores demostramos, que valores bajos de pepsinógeno (PG) y la infección por Helicobacter pylori-CagA+ están asociados con el riesgo de atrofia gástrica y cáncer en poblaciones costarricenses. OBJETIVO: Determinar cómo se distribuyen los marcadores de riesgo de cáncer gástrico en una población representativa de adultos de Costa Rica para diseñar una estrategia de tamizaje. MÉTODOS: Se estudió una población representativa a nivel nacional de 2.652 adultos, que formaron parte de un estudio longitudinal sobre envejecimiento. Se dispone de información sobre factores epidemiológicos, demográficos, nutricionales y de estilo de vida. Las concentraciones séricas de PG, así como el estado de H. pylori y CagA se determinaron mediante serología. Las posibles asociaciones se determinaron mediante modelos de regresión (logística y lineal múltiple). RESULTADOS: El 72% de la población presenta anticuerpos contra H. pylori, de ellos, el 58% fueron positivos para CagA. La infección por H. pylori se asoció con altas concentraciones de PGI (p = 0,000) y la infección por H. pylori-CagA+ con bajas concentraciones de PGI (p = 0,025). Ambas pruebas mostraron asociación con una baja razón PGI/PGII (p = 0,006 y p = 0,000). El rango de mayor edad se asoció con una menor prevalencia de la infección por H. pylori (OR = 0,98; p = 0,000) y de CagA+ (OR = 0,98; p = 0,000) pero no se asoció con los valores de PG. Las regiones con alto riesgo de CG mostraron valores bajos de PGI (p = 0,004) y de PGI/PGII (p = 0,021) así como una alta prevalencia de la infección por H. pylori (OR = 1,39; p = 0,013), no así con CagA+. Utilizando valores de corte de PGI<100 µg/L y de PGI/PGII <2,0, 2,5 y 3,0, se consideraría en riesgo de cáncer entre 7-15% de la población. CONCLUSIONES: La infección por H. pylori, por sí sola, no es un marcador de riesgo de CG útil. Es factible realizar el tamizaje de adultos de la población general de Costa Rica, utilizando como marcadores las concentraciones séricas de pepsinógenos y la infección por H. pylori-CagA+, sin embargo, los valores de corte apropiados deben determinarse con base en una mayor cantidad de datos clínicos y la capacidad de seguimiento.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Stomach Neoplasms , Helicobacter pylori , Costa Rica , Gastritis, AtrophicABSTRACT
Abstract The aim of this work is to describe and analyze the association of PGI/PGII ratio (indicator of gastric atrophy) with H. pylori-CagA and life style factors such as caloric intake, obesity, and harmful habits amongst H. pylori-positive elderly people infected in Costa Rica using an exploratory multigroup structural equations model (SEM). Using a sample of 1748 H. pylori-positive elderly people from CRELES first wave study, a SEM was employed analyze if the relationships between PGI/PGII ratio with levels of H. pylori-CagA, caloric intake, obesity, and harmful habits, differs by sex, age and risk areas subgroups. The proposed SEMs exhibited a good fit in males (RMSEA = 0.039), females (RMSEA = 0.000), low-risk area (RMSEA = 0.038), middle-risk area (RMSEA = 0.042), individuals under 80 years (RMSEA = 0.038) and individuals aged 80 and over (RMSEA = 0.042), while an acceptable fit was observed for the high-risk area (RMSEA = 0.061). Fitted SEMs showed that CagA predicted PG-ratio as expected, with effects increasing with the risk area, but similar between sex and age groups. All indicators measuring obesity (BMI, arms, and waist) showed significant standardized coefficients, with similar effects between sex, age and risk area groups. No other significant effects or differences between groups were identified. We propose a good-fitted SEM model for the possible relationships between CagA and PG ratio and the geographical risk area level for elderly people. No differences were observed on measured parameters between male and female population, or between under 80 years and older individuals.
Resumen El objetivo de este trabajo es describir y analizar la asociación entre PGI/PGII (indicador de atrofia gástrica con H. pylori-CagA y factores asociados a estilo de vida como ingesta calórica, obesidad y hábitos nocivos entre adultos mayores positivos por H. pylori en Costa Rica utilizando modelos de ecuaciones estructurales multigrupo (SEM). Con una muestra de 1748 adultos mayores del estudio CRELES, se utilizó un SEM para analizar las relaciones entre PGI/PGII, CagA, ingesta calórica, obesidad y hábitos nocivos difieren por sexo, edad y áreas de riesgo. Los SEMs propuestos exhibieron un buen ajuste en hombres (RMSEA = 0.039), mujeres (RMSEA = 0.000), área de bajo riesgo (RMSEA = 0.038), áreas de riesgo medio (RMSEA = 0.042), individuos menores de 80 años (RMSEA = 0.038) e individuos de 80 años o más (RMSEA = 0.042), mientras que hubo un ajuste aceptable en áreas de alto riesgo (RMSEA = 0.061). Los SEMs ajustados mostraron que CagA predice la relación PGI/II en la dirección esperada con efectos proporcionales al área de riesgo, pero no por sexo y edad. Todos los indicadores medibles de obesidad (IMC, brazos y cintura) mostraron coeficientes estandarizados significativos con efectos similares entre los grupos por sexo, edad y área de riesgo. No se encontraron otros efectos o diferencias significativas. Proponemos un modelo SEM bien ajustado para las posibles relaciones entre CagA y PGI/II y el nivel de riesgo del área geográfica en adultos mayores. No se encontraron diferencias en las variables analizadas entre hombres y mujeres ni entre los grupos de edad.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Helicobacter pylori , Energy Intake , Gastritis, Atrophic , ObesityABSTRACT
Objective:To evaluate the value of serum pepsinogen Ⅰ and Ⅱ combined with gastrin-17 in screening precancerous lesions of gastric cancer in physical examination population.Methods:Serum pepsinogen, gastrin-17 and Helicobacter pylori (Hp) antibody were detected in 18 354 physical examination people from July to December 2017 in Wenrong Hospital, Hengdian, Dongyang. The patients were divided into youth group (18 to 39 years old), middle-aged group (40 to 59 years old) and elderly group (≥60 years old) according to their ages. The correlation between the serological level of the above indexes and age was analyzed; according to the new ABC method, the test results were divided into groups A, B, C and D. The patients in group C and D were examined by gastroscopy. The differences of gastric mucosal atrophy or intestinal metaplasia and other precancerous lesions detected by gastroscopy in different age groups were compared.Results:Finally, 18 354 cases were enrolled, including 9 614 males and 8 740 females. With the increase of age, the proportion of group C and D increased gradually. In group C, 181 cases underwent gastroscopy, including 39 cases of atrophic gastritis, 29 cases of intestinal metaplasia and 3 cases of dysplasia/intraepithelial neoplasia, the detection rate of precancerous lesions was 39.23%; in group D, 94 cases underwent gastroscopy, including 22 cases of atrophic gastritis and 13 cases of intestinal metaplasia, the detection rate of precancerous lesions was 37.23%. The proportion of gastric precancerous lesions in group C and D was 29.63% in the young group, 69.70% in the middle-aged group and 71.58% in the old group, respectively. There was significant difference compared with the young group ( P<0.01); atypical hyperplasia occurred in 2.02% and 9.47% of the middle-aged group and the elderly group. Conclusions:The combined detection of serum pepsinogen Ⅰ and Ⅱ and gastrin-17 levels is of great value in the screening of precancerous lesions of gastric cancer; when this method used for early gastric cancer screening in healthy population, it is necessary to consider the influence of age for the risk stratification of gastric cancer.
ABSTRACT
Objective:To explore the clinical significance of standardized screening for diagnosis and treatment of early gastric cancer in Qinghai Province.Methods:Opportunistic early gastric cancer screening was conducted in outpatients of Digestive Department, Physical Examination Center and inpatients of Qinghai Provincial People′s Hospital from January 2016 to December 2020, according to the optimal cut-off values of serum pepsinogen (PG)Ⅰ, PGⅠ/PGⅡ ratio (PGR) and serum gastrin 17 (G17) obtained from the previous screening study of gastric cancer and precancerous diseases in different areas of Qinghai Province. At the same time, the standardized early gastric cancer screening program was applied in 10 municipal (county-level) hospitals in Qinghai Province. The detection rate, early diagnosis rate and endoscopic treatment rate of early gastric cancer in Qinghai Provincial People′s Hospital and the above 10 hospitals in the past five years were analyzed respectively.Results:In the five years, the total detection rate, early diagnosis rate and endoscopic treatment rate of early gastric cancer in Qinghai Provincial People′s Hospital were 0.214% (407/190 178), 17.54% (407/2 321) and 81.82% (333/407), respectively. The above indices in 10 other hospitals were 0.085% (264/309 217), 12.94% (264/2 040) and 37.12% (98/264), respectively. The overall detection rate of early gastric cancer was higher than 0.024% reported previously.Conclusion:The standardized early gastric cancer screening program can not only improve the diagnosis rate of early gastric cancer in Qinghai Province, but also save medical resources. It is an economical, efficient and feasible program, suitable for the highin-cidence area of gastric cancer in Qinghai Province.
ABSTRACT
Background: Serum pepsinogens (PGs), as an indicator of gastric mucosal atrophy, reflects the functional and morphological status of gastric mucosa. And OLGA/OLGIM, the staging system of gastritis integrating the severity and topography of gastric mucosal atrophy/intestinal metaplasia, has been gradually accepted and used in gastric cancer screening in recent years. Aims: To investigate the correlation between ABC method [combined assay for serum Helicobacter pylori (Hp) antibody and PGs] and OLGA/OLGIM staging system, as well as the role of PGs test in risk assessment of gastric precancerous lesions. Methods: A total of 331 patients undergoing gastroscopy for upper gastrointestinal symptoms from Jan. 2017 to Jan. 2018 at the First Hospital of Jiaxing were enrolled. According to the results of serum tests and biopsy pathology, these patients were divided into four groups by ABC method and five groups by OLGA/OLGIM staging system, respectively. Hp infection rate, serum levels of PG and PGⅡ, and PG/PGⅡ ratio (PGR) were compared between different OLGA/OLGIM groups, and the correlations between OLGA/OLGIM staging system and ABC method were analyzed. Results: For OLGA/OLGIM staging system, the Hp infection rate was significantly lower in stage-0 and significantly higher in stage- (P<0.05), whereas the PGR decreased with the rising of stage (P<0.05). Only in OLGA groups, the PG level decreased with the rising of stage (P<0.05). Gamma coefficient analysis showed significant correlation between OLGA/OLGIM staging system and ABC method (G=0.589, P<0.05; G=0.440, P<0.05). Conclusions: Serological ABC method and histological OLGA/OLGIM staging system are closely linked in risk assessment of gastric precancerous lesions. Serum PGs test could be applied for screening of gastric precancerous lesions in China, identifying high risk population for further gastroscopy.
ABSTRACT
Background: The prognosis of early gastric cancer is significantly better than that of advanced gastric cancer. Because of the lacking of rational screening means, the detection rate of early gastric cancer is low. Serum pepsinogen Ⅰ (PGⅠ), PGⅡ, gastrin-17 (G-17) can be used for the screening of early gastric cancer. Aims: To investigate the value of new screening scoring system of gastric cancer for detecting patients with early gastric cancer in local region. Methods: A total of 393 patients from April 2017 to December 2018 were enrolled. According to pathological findings, patients were divided into control group, gastric ulcer group, dysplasia group and early gastric cancer group. Levels of PGⅠ, PGⅡ, G-17, Hp antibody were detected, and PGR was calculated. ROC curve was used to analyze the value of parameters for detecting early gastric cancer. Detection rates of early gastric cancer via serum ABC method, new ABC method and new screening scoring system were compared. Results: Compared with control group, serum PGⅠ and PGⅡ in gastric ulcer group were significantly increased, PGR was significantly decreased (P12.80 pmol/L and ≤6.90, respectively, the combination of these three indices for screening early gastric cancer had a sensitivity of 90.6%, specificity of 91.1%, and AUC of 0.965. The detection rate of early gastric cancer via new screening scoring system was significantly increased than that of serum ABC method, however, no significant difference was found between new screening scoring system and new ABC method (P>0.05). Conclusions: Decreased serum PGⅠ, PGR and increased G-17 may suggest the occurrence of early gastric cancer. New screening scoring system of gastric cancer is an efficient method for screening early gastric cancer.
ABSTRACT
Objective@#To evaluate the feasibility of pepsin strip test in the diagnosis of laryngopharyngeal reflux.@*Methods@#From August 2017 to September 2018,80 patients in Department of Otorhniolaryngology Head and Neck Surgery,Chinese People′s Liberation Army General Hospital-Six Medical Centre, underwent pepsin strip test and 24-hour multichannel intraluminal impedance(MII)-pH monitoring. The results of the two methods were analyzed for consistency,and 24-hour MII-pH monitoring was used as a statistical reference for the sensitivity and specificity of pepsin strip test in the diagnosis of laryngopharyngeal reflux. Data were analyzed by SPSS 19.0 software.@*Results@#There were 57 patients with positive pepsin test strip and 23 patients with negative pepsin test strip. The score of reflux symptoms and signs, and the positive rate of laryngopharyngeal reflux events in patients with positive pepsin strip test were significantly higher than those in patients with negative pepsin test strip. If there was one or more throat reflux events (including acid reflux,weak acid reflux and alkali reflux) as the positive results of 24-hour MII-pH monitoring,the consistency between the results of pepsin strip and 24-hour MII-pH was moderate (Kappa=0.614). The sensitivity and specificity of pepsin strip were 86.9% (53/61) and 78.9% (15/19) respectively.@*Conclusions@#Pepsin strip detection has the advantages of non-invasive,cheap and easy to operate.As an objective method for early diagnosis of laryngopharyngeal reflux, pepsin strip detectionis feasible,but can not be the final diagnosis for laryngopharyngeal reflux disease.
ABSTRACT
OBJECTIVE: To evaluate the predictive value of various gastric cancer risk scoring systems based on the detection of pepsinogen and gastrin 17 for the risk of developing gastric cancer. METHODS: One hundred and forty-four patients were enrolled into the study from the First Affiliated Hospital of Anhui Medical University between April 2018 and October 2018.Among them, seventyfour patients were diagnosed with early gastric cancer while seventy patients didn't have gastric cancer(control group). The levels of serum pepsinogen I(PGI)/pepsinogen II(PGII), gastrin-17(G-17) and H.pylori antibody were measured. Patients were scored according to the Japanese ABC method, the modified ABC method, and the Chinese new gastric cancer risk scoring system. Compare the accuracy of the three methods for predicting the risk of developing gastric cancer. RESULTS: Compared with the control group, there was no significant difference in PG levels between the two groups, the serum G-17 levels were lower in gastric cancer patients than those in control group(P<0.05). According to the ABC method, the incidence rates of gastric cancer in the four groups of ABCD were 48.6%,59.4%, 0.0% and 100% respectively; the incidence rates of gastric cancer in the three groups of modified ABC method were 57.6%, 35.9% and 50% respectively. The cut-off value of new gastric cancer risk scoring system to diagnose gastric cancer was 11. The sensitivity,specificity, accuracy, positive predictive value and negative predictive value were 64.8%, 71.4%, 68.1%, 70.6 and 65.8% respectively. But in the low risk group, there were 26 cases(35.1%) of gastric cancer. Comparing the low-risk with the middle-high-risk population of gastric cancer, there were more females in the low risk group. CONCLUSION: The Japanese ABC method and the modified ABC method have value for limited screening gastric cancer and are not suitable for China's national conditions. The screening efficacy of the new gastric cancer scoring system for gastric cancer is significantly higher than the other two methods; however we should be vigilant when it is used in women with low risk.
ABSTRACT
Objective@#To investigate the clinical value of serum pepsinogen (PG), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) in diagnosis, prognosis evaluation and postoperative monitoring of gastric cancer.@*Methods@#A total of 100 patients diagnosed by the gastroscope in the Third People's Hospital of Hefei from January 2016 to October 2018 were selected. The patients were divided into the non-atrophic gastritis group (50 cases) and the gastric cancer group (50 cases) according to histopathological results. Enzyme linked immunosorbent assay (ELISA) was used to detect the levels of serum PGI and PGII. The ratio of PGI and PGII ratio (PGR) was calculated. Radioimmunoassay was used to detect CEA and CA19-9 levels.@*Results@#Serum PGI and PGR in the gastric cancer group were lower than those in the non-atrophic gastritis group [PGI: (96±35) μg/L vs. (144±44) μg/L; PGR: 7±3 vs. 11±5], and there was a significant difference (t = 3.861, P < 0.01; t = 3.043, P = 0.003]. Serum CEA and CA19-9 in the gastric cancer group were higher than those in the non-atrophic gastritis group [(7.5±4.8) ng/ml vs. (1.5±0.6) ng/ml, (49.7±29.4) U/ml vs. (8.7±2.6) U/ml], and there were statistical differences (t = 3.100, P = 0.003; t = 3.139, P = 0.002). Serum PGR of the gastric cancer group was decreased in TNM Ⅲ-Ⅳ stage, poorly differentiated adenocarcinoma and lymph node metastasis (t = 2.185, P = 0.034; t = 2.197, P = 0.033; t = 2.130, P = 0.038); CA19-9 of the gastric cancer group was increased in TNM stage (Ⅲ-Ⅳ stage) and lymph node metastasis (t = 2.405, P = 0.020; t = 2.076, P = 0.043). There were no statistical differences in PGⅠ, PGⅡ and CEA of gastric cancer patients with different clinicopathological characteristics (all P > 0.05). Serum PGⅠ [(46±23) μg/L] and PGⅡ [(8±5) μg/L] were decreased in the postoperative gastric cancer group (t = 4.263, P < 0.01; t = 5.830, P < 0.01). Serum CEA and CA19-9 of the postoperative metastatic group were higher than those of the postoperative non-metastatic group [(35.3±14.5) ng/ml vs. (3.6±2.2) ng/ml, (126±57) U/ml vs. (27±12) U/ml].@*Conclusion@#Combined detection of serum PGⅠ, PGⅡ, CEA and CA19-9 could be used for the diagnosis and prognosis evaluation of gastric cancer, and it has a certain clinical value for postoperative metastasis monitoring of gastric cancer.
ABSTRACT
Objective To compare the consistency and detection rate of early gastric cancer (EGC) of three different methods including anti-Helicobacter pylori (Hp) antibody combined with pepsinogen (PG) (ABC method),serum PG combined with gastrin-17 (G-17) (new ABC method) and the new scoring system.Methods Serological tests were performed in Zhejiang population,which divided the subjects into low risk,intermediate risk and high risk groups.High risk subjects were examined by endoscopic and pathological examination.SPSS19.0 were used to evaluate the consistency of three methods.According to the receiver operating characteristic (ROC) curve,the ratio of G-17 to PG (PGR) was calculated for the optimal diagnostic cut-off value of EGC.Results A total of 30 126 subjects were recruited.Based on the data of ABC method,the proportions of low risk,intermediate risk and high risk group were 15 368 (51.01％),13 246 (43.97％),and 1 512 (5.02％),respectively.These proportions by the new ABC method were 20 584 (68.32％),8 990 (29.84％),552 cases (1.83％),respectively.By new scoring system,these were 20 810 (69.08％),8 059 (26.75％),and 1 257 (4.17％),respectively.Among them,1 263 subjects underwent endoscopy and 22 cases (1.74％) were finally diagnosed as gastric cancer including 19 EGC (86.4％).There were 1 case (0.35％),14 cases (1.84％),and 7 cases (3.21％) with gastric cancer in low risk,intermediate risk,and high risk groups by ABC methods,respectively.Gastric cancer patients were 7 (1.68％),10 (1.38％),and 5 (4.10％) in three groups respectively by new ABC methods.Via new scoring system,gastric cancer were detected in 5 (0.66％),9 (2.22％),and 8 (7.84％) patients of three risk groups respectively.The consistency of three screening methods was poor.The detection rate of gastric cancer in high risk group was higher than that in the other two (P＜0.05).The area under the curve (AUC) for diagnosis of gastric cancer by G-17 and PGR was 0.588 and 0.729,respectively.According to the PGR cut-off value determined by the fitted model,the incidence of gastric cancer in the low,intermediate and high risk groups was 0.94％,1.97％,and 6.31％,respectively.When the cut-off value is PGR＜4.135,the sensitivity is 0.855 and the specificity is 0.545.Conclusion The new scoring system has a better predictive value in EGC screening.The detection rate of EGC in high risk group is higher than that in low and intermediate risk groups.
ABSTRACT
Objective To investigate the clinical value of serum pepsinogen (PG), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) in diagnosis, prognosis evaluation and postoperative monitoring of gastric cancer. Methods A total of 100 patients diagnosed by the gastroscope in the Third People's Hospital of Hefei from January 2016 to October 2018 were selected. The patients were divided into the non-atrophic gastritis group (50 cases) and the gastric cancer group (50 cases) according to histopathological results. Enzyme linked immunosorbent assay (ELISA) was used to detect the levels of serum PGI and PGII. The ratio of PGI and PGII ratio (PGR) was calculated. Radioimmunoassay was used to detect CEA and CA19-9 levels. Results Serum PGI and PGR in the gastric cancer group were lower than those in the non-atrophic gastritis group [PGI: (96±35) μg/L vs. (144±44) μg/L; PGR: 7±3 vs. 11±5], and there was a significant difference (t=3.861, P<0.01; t=3.043, P=0.003]. Serum CEA and CA19-9 in the gastric cancer group were higher than those in the non-atrophic gastritis group [(7.5 ±4.8) ng/ml vs. (1.5 ±0.6) ng/ml, (49.7±29.4) U/ml vs. (8.7±2.6) U/ml], and there were statistical differences (t= 3.100, P= 0.003; t= 3.139, P= 0.002). Serum PGR of the gastric cancer group was decreased in TNM Ⅲ-Ⅳ stage, poorly differentiated adenocarcinoma and lymph node metastasis (t= 2.185, P= 0.034; t= 2.197, P= 0.033; t= 2.130, P=0.038); CA19-9 of the gastric cancer group was increased in TNM stage (Ⅲ-Ⅳ stage) and lymph node metastasis (t= 2.405, P= 0.020;t= 2.076, P= 0.043). There were no statistical differences in PGⅠ, PGⅡand CEA of gastric cancer patients with different clinicopathological characteristics (all P> 0.05). Serum PGⅠ[(46±23)μg/L] and PGⅡ[(8±5)μg/L] were decreased in the postoperative gastric cancer group (t=4.263, P<0.01; t=5.830, P<0.01). Serum CEA and CA19-9 of the postoperative metastatic group were higher than those of the postoperative non-metastatic group [(35.3±14.5) ng/ml vs. (3.6±2.2) ng/ml, (126±57) U/ml vs. (27±12) U/ml]. Conclusion Combined detection of serum PGⅠ, PGⅡ, CEA and CA19-9 could be used for the diagnosis and prognosis evaluation of gastric cancer, and it has a certain clinical value for postoperative metastasis monitoring of gastric cancer.
ABSTRACT
BACKGROUND/AIMS: Limited information is available about the relationship between Helicobacter pylori (H. pylori) immunoglobulin (Ig) G and serum pepsinogen (pepsinogen [PG], a marker of gastric mucosal atrophy) concentrations after H. pylori eradication. MATERIALS AND METHODS: Eligible patients who underwent endoscopic submucosal dissection (ESD) for early gastric cancer from August 2007 to March 2013 in a tertiary-referral center, and whose serum H. pylori IgG and PG concentrations were measured at the time of performing ESD and one year post-ESD, were selected. Successful H. pylori eradication was achieved after ESD in all the patients. According to the decrease in serum H. pylori IgG concentration after bacterial eradication, the patients were categorized as group 1 (IgG concentration decreased by <50%), and group 2 (IgG concentration decreased by ≥50%). RESULTS: Of the 106 patients, 25 (23.6%) were classified into group 1 and 81 (76.4%) into group 2. One year after H. pylori eradication, the serum PG II concentration was significantly decreased in group 2 (12.46±8.18 vs. 8.28±6.11, P=0.024). Although the serum PG I/II ratio of group 2 was higher than that of group 1 (8.32±4.52 ng/mL vs. 6.39±4.04 ng/mL), the difference was not significant (P=0.058). One year after successful eradication, elevated serum PG I/II ratio was observed in 21 patients (84%) in group 1 and in 77 patients (95.1%) in group 2 (P=0.087). The mean serum PG I/II ratio was also elevated in both groups. Serum PG II concentration was significantly decreased in group 2. CONCLUSIONS: A notable decrease in the concentration of H. pylori IgG antibody after bacterial eradication might reflect gastric mucosal atrophy. However, our study showed no statistically significant difference.
Subject(s)
Humans , Atrophy , Helicobacter pylori , Helicobacter , Immunoglobulin G , Immunoglobulins , Mucous Membrane , Pepsinogen A , Pepsinogens , Stomach NeoplasmsABSTRACT
Objective To compare the diagnostic value of the old "ABC" method [serum pepsinogen(PG) combined with Helicobacter pylori (Hp) IgG antibody] and the new "ABC" method [serum pepsinogen plus gastrin-17(G-17)] in screening gastric cancer and its precancerous condition. Methods Serum PG, G-17 and Hp-IgG were quantified by enzyme-linked immunosorbent assay (ELISA) in 278 subjects. Subjects were grouped according to the criteria of two methods. The gastroscopy and pathological biopsy were gold standard. Results The positive rate of old "ABC" method was 74.46% (207/278), which was 54.68% of new "ABC" method (151/278). For the diagnosis of gastric cancer, the sensitivity and specificity of the old "ABC" method were 90.74% and 29.46% respectively, with diagnostic coincidence rate 41.37%. The sensitivity and specificity of the new "ABC" method were 92.59% and 54.46% respectively, with diagnostic coincidence rate 61.87%. As to the diagnosis of pre-cancerous state, the sensitivity and specificity of the old "ABC" method were 75.81% and 36.00%, with diagnostic coincidence rate 58.03%. The sensitivity and specificity of the new "ABC" method were 62.10% and 75.00%, with diagnostic coincidence rate 67.86%. Conclusions Compared with the old "ABC" method, the new "ABC" method has higher sensitivity, specificity and diagnostic coincidence rate for the diagnosis of gastric cancer, yet higher specificity and lower sensitivity for the diagnosis of precancerous conditions.
ABSTRACT
Background:Chronic atrophic gastritis(CAG)is a common disease of digestive system and is a precancerous lesion of the intestinal type gastric cancer. Serum pepsinogens(PGs)and gastrin 17(G17)are biological markers of gastric mucosal lesions,which have a prominent role in diagnosis of CAG and screening of early gastric cancer. Aims:To study the correlation of serum PGs and G17 with age in patients with CAG. Methods:A total of 582 CAG patients admitted from Jan. 2016 to Sep. 2017 at the Baoding First Central Hospital were enrolled. The levels of serum PGⅠ,PGⅡ and G17 were determined by ELISA,and the PGⅠ/ PGⅡ ratio(PGR)was calculated. The correlations of these indices with the clinical data of CAG patients were analyzed. Results:The levels of serum PGⅠ and PGⅡ were increased with age(P<0.01),and the levels of PGR and G17 were decreased with age(P <0.05). Spearman rank correlation coefficient analysis showed that the levels of PGⅠ and PGⅡ were positively correlated with age(rs=0.374,P<0.01;rs=0.559, P<0.01),and the levels of PGR and G17 were negatively correlated with age(rs= -0.649,P<0.01;rs= -0.141, P<0.05). Conclusions:The levels of serum PGⅠ,PGⅡand G17 in patients with CAG were correlated with age. When serum PGs and G17 are used as serological indicators for diagnosis of CAG and screening of early gastric cancer,the impact of age on these indices should be taken into account.
ABSTRACT
Gastric cancer is one of the most common malignant tumors in China. The 5-year survival rate of advanced gastric cancer is less than 30%,while the 10-year survival rate of early gastric cancer can reach 90%. Gastric cancer screening is the primary means of detecting early gastric cancer and reducing its mortality. Helicobacter pylori(H. pylori) infection is the most important cause of gastric cancer. Eradication of H. pylori can reduce the incidence of gastric cancer and its mortality. This review summarized recent advances in screening methods,screening subjects,screening procedures, and the combination of gastric cancer screening with H. pylori detection/eradication strategy.
ABSTRACT
Background:It is widely accepted that even low-dose aspirin can cause upper gastrointestinal injury.Studies showed the correlation of serum pepsinogens (PGs) with gastric acid secretion and Helicobacter pylori (Hp) infection is independently associated with peptic ulcer disease.Aims:To study the correlation of serum PGs and Hp infection with gastroduodenal injury induced by aspirin therapy.Methods:Two hundred and forty patients taking aspirin for 1-3 months admitted from Aug.2013 to May 2016 at the East Hospital Affiliated to Tongji University were enrolled.The levels of serum PG Ⅰ,PGⅡ and gastrin 17 (G17) were determined by ELISA.The Hp infection was detected by 14C-urea breath test.The modified Lanza score was used to assess the severity of gastroduodenal mucosal injury endoscopically.Results:The median serum PG Ⅰ level (154.61 ng/mL vs.117.15 ng/mL,P =0.00) and Hp infection rate (75.0％ vs.40.0％,P =0.00) in patients with intensive gastroduodenal injury (IGI) were significantly higher than those in patients with mild gastroduodenal injury (MGI),while no significant differences in serum PG Ⅱ and G17 levels were seen between the two groups (P ＞ 0.05).Univariate and multivariate analyses showed that serum PG Ⅰ and Hp infection were independent risk factors for aspirin-associated gastroduodenal injury.ROC curve analysis revealed that serum PG Ⅰ was the best indicator of aspirin-associated IGI,and the cut-off value,sensitivity and specificity were 125.50 ng/mL,80.15％ and 62.54％,respectively.The risk of IGI was significantly increased in patients with serum PG Ⅰ ≥ 125.50 ng/mL and positive for Hp infection (OR =16.87,95％ CI:2.04-135.44).Conclusions:High serum PG Ⅰ level (≥ 125.50 ng/mL) and Hp infection are risk factors for aspirin-associated gastroduodenal injury.Their combination detection can be used to identify potential patients with high risk of aspirin-associated gastroduodenal injury.
ABSTRACT
<p><b>Objective</b>Gastroscopy combined with gastric mucosa biopsies is currently regarded as a gold standard for diagnosis of gastric cancer. However, its application is restricted in clinical practice due to its invasive property. A new noninvasive population screening process combining the assay of anti-Helicobacter pylori antibody and serum pepsinogen (PG) (ABC method) is adopted to recognize the high-risk patients for further endoscopy examination, avoiding the unnecessary gastroscopy for most population and saving the cost consumption for mass screening annually. Nevertheless, controversies exist for the grouping of ABC method and the intervals of gastroscopy surveillance for each group. In this review, we summarized these popular concerned topics for providing useful references to the healthcare practitioner in clinical practice.</p><p><b>Data Sources</b>The PubMed databases were systematically searched from the inception dates to November 22, 2017, using the keywords "Helicobacter pylori," "Pepsinogens," and "Stomach Neoplasms."</p><p><b>Study Selection</b>Original articles and reviews on the topics were selected.</p><p><b>Results</b>Anti-H. pylori antibody and serum PG concentration showed significant changes under the different status of H. pylori infection and the progression of atrophic gastritis, which can be used for risk stratification of gastric cancer in clinic. In addition, anti-H. pylori antibody titer can be used for further risk stratification of gastric cancer contributing to determine better endoscopy surveillance interval.</p><p><b>Conclusions</b>The early detection and diagnosis of gastric cancer benefit from the risk stratification, but the cutoff values for H. pylori antibody and serum PG concentration require further modification.</p>
Subject(s)
Humans , Antibodies, Bacterial , Blood , Allergy and Immunology , Gastroscopy , Helicobacter Infections , Blood , Allergy and Immunology , Helicobacter pylori , Allergy and Immunology , Mass Screening , Methods , Stomach Neoplasms , Blood , MicrobiologyABSTRACT
Objective To explore the relationship between serum pepsinogen (PG), PGⅡ, PG ratio (PGR), gastrin 17 (G17) and gastric cancer, and to provide the basis for the early diagnosis and differential diagnosis of gastric cancer. Methods Two hundred and forty-eight cases of gastric disease diagnosed with gastroscopy in Baoji Central Hospital from December 2015 to February 2017 were selected as study subjects. According to the results of histopathology, the patients were divided into 4 groups: gastric cancer group (47 cases), chronic atrophic gastritis group (52 cases), chronic non-atrophic gastritis group (81 cases), gastric ulcer group (68 cases). Meanwhile, 50 cases healthy people were enrolled as the control group. The levels of serum PGⅠ, PGⅡ and G17 were measured by enzyme linked immunosorbent assay (ELISA). Results The levels of PGⅠ and PGR in gastric cancer group were lower than those in other groups [PGⅠ: (43±7) vs. (47±7), (69±14), (75±17), (112±22) μg/L; PGR: 5.6±0.5 vs. 10.3±2.6, 10.5±2.5, 11.9±2.7, 14.6± 3.5], and there was a significant difference (PGⅠ: F= 58.42, P = 0.000; PGR: F= 6.15, P = 0.034). The level of serum G17 in gastric cancer group was significantly higher than that in other groups [(43.8±4.3) vs. (22.4±3.6), (10.7±2.1), (13.2±2.4), (5.8±1.3) pmol/L, F= 43.22, P = 0.000]; The PGⅠ, PGR and G17 combined detection of sensitivity(88.6 %), specificity(97.5 %), area under the curve(0.986) was significantly higher than that of single detection(78.3 %, 89.0 %, 88.4 %; 72.9 %, 87.0 %, 73.2 %; 0.848, 0.912, 0.923, respectively; χ2= 7.86, 6.42, 9.10; P = 0.019, 0.044, 0.012). The regression equation provided a basis for confirmation or exclusion of gastric cancer. Conclusions Serum PGⅠ, PGR, G17 and gastric cancer has a good correlation. Combined detection of serum PGⅠ, PGR and G17 could be used for the diagnosis and differential diagnosis of gastric cancer.
ABSTRACT
Background:Serum pepsinogens (PGs),as a serologic marker for gastric mucosal lesions,can reflect the functional status of gastric mucosa. Helicobacter pylori (Hp)infection can cause pathological changes in gastric mucosa,and has been reported to influence the serum level of PGs. Aims:To explore the influence of Hp infection on diagnostic performance of serum PGs for gastric mucosal lesions. Methods:The endoscopic findings,biopsy pathology (including Giemsa staining) and serum PGs test in 1216 cases of patients from July 2014 to June 2015 at the First Affiliated Hospital of Jiaxing University were collected. Patients were categorized according to the pathological diagnosis and Hp status,and the results of serum PGs test were analyzed between different groups. Results:When patients were classified by gastric mucosal lesion,no significant differences were found in serum levels of PGⅠ,PGⅡ,ratio for PGⅠ/ Ⅱ (PGR)and proportion of PG-positive (PGⅠ≤70 μg/ L and PGR < 3. 0)patients of different mucosal lesion groups with Hp-positive status (P >0. 05),whereas significant differences were observed in serum levels of PGⅠ,PGⅡ,PGR and proportions of patients with PGⅠ≤70 μg/ L or PGR < 3. 0 of different mucosal lesion groups with Hp-negative status (P < 0. 05). When patients were classified by Hp status,PGⅠ level and PGR were lower and PGⅡ level and proportion of PG-positive patients were higher in Hp-positive patients than in Hp-negative patients in any of the gastric mucosal lesion groups (P < 0. 05 in part of the comparisons). Conclusions:Hp infection is strongly associated with the alterations in serum PGs test,which narrows the differences in PGs between groups with different gastric mucosal lesions and expands that within the same mucosal lesion, subsequently decreasing PGR and increasing the proportion of PG-positive patients. Patients negative for Hp infection may need new cut-off value of serum PGs test to improve the sensitivity for diagnosis of gastric mucosal lesion.