The Value of Pepsinogen in GC Screening: A Systematic Review and Meta-Analysis

Abstract

Background The current gold standard for gastric cancer (GC) screening is pathology or a barium meal followed by X-ray. This is not applicable to a wide range of screening capabilities due to the lack of operability. This article used a meta-analysis to evaluate the value of pepsinogen (PG) screening for GC. Methods PubMed, EMbase, the Cochrane Library, CNKI, WanFang, VIP, and CBM databases were systematically searched for published studies that used serum PG to diagnose GC. Articles were searched from January 2003 to January 2018. Two reviewers independently screened the literature according to specified inclusion and exclusion criteria. The data were extracted and evaluated, and the quality of the methodologies evaluated using the QUADAS entry. The meta-analysis (MA) was performed using Meta-DiSc 1.4 software. Stata 12.0 software was used to assess publication bias. Results A total of 19 studies were finally included from a total of 169,009 cases. The MA showed a combined sensitivity and specificity of 0.56 (95% CI (0.53–0.59), P < 0.01) and 0.71 (95% CI (0.70-0.71), P < 0.01), respectively. The combined likelihood ratios were +LR = 2.82 (95% CI (2.06–3.86), P < 0.01) and −LR = 0.56 (95% CI (0.45–0.68), P < 0.01). The combined DOR was 5.41 (95% CI (3.64~ 8.06), P < 0.01), and the area under the SROC curve was 0.7468. Conclusions Serum PG provides medium levels of sensitivity and specificity for GC assessment. To be used in a clinical setting, further high-quality research must be performed and verified.

Prediction of Chronic Atrophic Gastritis and Gastric Neoplasms by Serum Pepsinogen Assay: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy

“…Compared to the previous meta-analyses that combined the diagnostic values with various cut-off standards in a single outcome, the results of this study showed slightly lower diagnostic values (AUC for the diagnosis of CAG: 0.81 vs. 0.85/AUC for the diagnosis of GC: 0.70 vs. 0.76/DOR for the diagnosis of GC: 4 vs. 5.41), indicating overestimation of diagnostic validity in previous studies [9,10].…”

“…Although various cut-off values have been suggested, the combination of PG I ≤70 ng/mL and PG I/PG II ratio ≤3 have been proposed for the prediction of CAG or GC [4,8]. However, previous meta-analyses for diagnostic test accuracy (DTA) presented only pooled outcomes, which cannot determine the diagnostic validity of sPGA with a cut-off value of PG I ≤70 ng/mL and PG I/PG II ratio ≤3 [9,10], although no threshold effect was detected [9]. This can lead to an exaggerated summary of performance because pooled analysis adopted the best performance value in each study, irrespective of cut-off values.…”

Serum pepsinogen II levels are doubled with Helicobacter pylori infection in an asymptomatic population of 40,383 Chinese subjects

“…It is believed that a low serum PGI level and low PGI/PGII ratio have been associated with severe gastric atrophy, intestinal metaplasia, and are frequently found in gastric cancer. [ 4 , 11 ]…”

Sensing gastric cancer via point‐of‐care sensor breath analyzer

“…13 However, the sensitivity of this approach as reported in metaanalyses ranges from 56% to 69%, though the specificity is 71% to 73%. 14,15 Even these numbers may be an overestimation, since several studies have demonstrated that normal pepsinogen levels are found in approximately two-thirds of patients who have gastric cancer. 11 The current study has demonstrated significantly better results for detecting gastric cancer when compared with pepsinogen measurements.…”

“…Currently, the best available noninvasive screening tools for atrophy, the precancerous lesion for gastric cancer, is detection of pepsinogen I and II levels in the circulation 13 . However, the sensitivity of this approach as reported in meta‐analyses ranges from 56% to 69%, though the specificity is 71% to 73% 14,15 . Even these numbers may be an overestimation, since several studies have demonstrated that normal pepsinogen levels are found in approximately two‐thirds of patients who have gastric cancer 11 .…”