Usefulness of Serum Pepsinogen Levels as a Screening Test For Atrophic Gastritis and Gastric Cancer

Abstract

Objective: The purpose of our study was to research the applicability of measuring serum pepsinogen I (PG I) and PG I/pepsinogen II (PG II) ratios as screening tests for atrophic gastritis, which is the most important predisposition for stomach cancer. Materials and Methods:We measured serum pepsinogen levels in non-specifi c gastritis, atrophic gastritis and gastric cancer using a radioimmunoassay method. We included in this study 30 healthy control, 30 nonspecifi c gastritis, 30 atrophic gastritis and 50 gastric cancer cases. Results:The serum PG I level was statistically higher in the control group and in the patient group with chronic nonspecifi c gastritis compared to the patient groups with chronic atrophic gastritis and stomach cancer (p<0.05). The best cutoff values for diagnosing stomach cancer using serum PG I and PG I / PG II ratios were found to be <25 ng/ml for PG I and <3.0 for PG I / PG II. The same cut-off values were also most eff ective for the patients with atrophic gastritis. Conclusions:Serum pepsinogen screening was shown to be a practical predictor of stomach cancer and atrophic gastritis, the most important predisposing lesion for stomach cancer. Although the diagnosis of stomach cancers localized in the pylorus and cardia via this method is diffi cult, we believe that the detection of early-stage cancers that develop following chronic atrophic gastritis in particular will be possible, and therefore the morbidity and mortality of stomach cancer will be decreased.

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

“…Among these studies, 115 articles were excluded from the final analysis due to the following reasons: narrative review article ( n = 13), letter, comment, editorial or reply to questions ( n = 1), study protocol ( n = 1), incomplete data ( n = 92), and systematic review/meta-analysis or consensus report ( n = 8). The remaining 14 studies [20,21,22,23,24,25,26,27,28,29,30,31,32,33] were included in the quantitative synthesis. Eight studies [20,23,24,27,29,30,31,32] adopted the cut-off standard of PG I ≤70 ng/mL and PG I/PG II ratio ≤3, eight studies [21,22,25,26,27,28,30,33] adopted the cut-off standard of PG I/PG II ratio ≤3, and only two studies [27,33] adopted the cut-off standard of PG I ≤70 ng/mL.…”

“…Among the 38 studies for the diagnosis of GC, 28 studies [35,36,37,38,40,41,42,43,46,48,49,50,51,53,54,56,57,58,59,60,62,63,65,66,70,71,72,73] adopted the cut-off standard of PG I ≤70 ng/mL and PG I/PG II ratio ≤3, 11 studies [26,38,39,44,45,47,52,57,65,68,69] adopted the cut-off standard of PG I/PG II ratio ≤3, and only six studies [34,45,57,64,65,69] adopted the cut-off standard of PG I ≤70 ng/mL.…”

Significance of Serum Pepsinogens as a Biomarker for Gastric Cancer and Atrophic Gastritis Screening: A Systematic Review and Meta-Analysis

“…Two of these articles were discarded because the data could not be extracted, 4 were discarded the studies did not present sensitivity, specificity, or clear cut-off values, 10 were discarded for having no correlation to the diagnostic accuracy test, 6 were discarded because of the combination of SPG and other serological markers, and 5 were discarded due to the application of SPG in GC diagnosis. Sixteen eligible articles were included in the present meta-analysis [ 12 , 31 , 33 – 46 ] ( Fig 1B ). No unpublished relevant studies were obtained.…”

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

“…When PGI ≤ 70 ng/mL and PGR ≤ 3, the sensitivity and specificity were 84.6% and 73.5%, respectively, which were considered the optimal cut-off point based on the available criteria. Agkoc et al [1] recorded an optimal cut-off value of PGI ≤ 25 ng/mL and a PGR < 3.0. The positive indicators of PG selected from each study also differed, which are reflected by the known variations of PG screening for GC in different countries and regions.…”

“…Gastric Cancer (GC) is the fifth most common malignancy worldwide [1]. Although the incidence and mortality of GC have decreased in recent years, it remains a leading cause of cancer-associated death [2].…”