Evaluation of Cutoff Levels for Screening of Gastric Cancer Using Serum Pepsinogens and Distributions of Levels of Serum Pepsinogen I, II and of PG I / PG II Ratios in a Gastric Cancer Case-Control Study

Aoki, Katsumi; Misumi, Jyuji; Kimura, Takashi; Zhao, Wei; Xie, Tongxin

doi:10.2188/jea.7.143

Cited by 43 publications

(32 citation statements)

References 7 publications

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“…For instance, men have higher normal PGⅠ values than women [18] , which is in agreement with the data on blood donors [19] . In contrast, in 20-70 year old Japanese, serum PG level is dependent on the age and PGⅠincreases gradually with age, while the PGⅠ/PG Ⅱ ratio decreases significantly [20] . In our study, the PGⅠ and PGⅡ levels were significantly higher in males than in females.…”

Section: Discussionmentioning

confidence: 79%

Serum pepsinogen levels and their infl uencing factors: A population-based study in 6990 Chinese from North China

Sun¹

2007

WJG

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AIM:To explore the essential characteristics of serum pepsinogen (PG) levels in Chinese people, by analyzing the population-based data on the serum levels of PG Ⅰ and Ⅱ and the PGⅠ/Ⅱ ratio, and their influencing factors in Chinese from North China. METHODS:A total of 6990 subjects, who underwent a gastric cancer screening in North China from 1997 to 2002, were collected in this study. Serum pepsinogen levels were measured by enzyme-linked immunosorbent assay (ELISA). H pylori status was determined by histological examination and H pylori -IgG ELISA. The cut-off point was calculated by using receiving operator characteristics (ROC) curves. Factors linked to serum PG Ⅰ/Ⅱ ratio were identified using a multivariate logistic regression. RESULTS:The serum PGⅠ and PGⅡ levels were significantly higher in males than in females (95.2 μg/L vs 79.7 μg/L, P < 0.01; 12.1 μg/L vs 9.4 μg/L, P < 0.01), PGⅠ/Ⅱ ratio was significantly lower in males than in females (7.9 vs 8.3, P < 0.01). The PG Ⅰ/Ⅱ ratio decreased significantly in the aged groups following the progression of gastric mucosa from normal to non-atrophic and atrophic lesions (10.4, 8.8, and 6.6, respectively). The serum PGⅠand Ⅱ levels were significantly higher in patients with H pylori infection than in those without H pylori infection (88.7 μg/L vs 81.4 μg/L, P < 0.01; 11.4 μg/L vs 8.4 μg/L, P < 0.01), while the PGⅠ/Ⅱ ratio was significantly lower in patients with H pylori infection than in those without H pylori infection (7.7 vs 9.6, P < 0.01). For patients with atrophic lesions, the area under the PGⅠ/Ⅱ ROC curve was 0.622. The best cut-off point for PGⅠ/Ⅱ was 6.9, with a sensitivity of 53.2%, and a specificity of 67.5%. Factors linked to PG Ⅰ/Ⅱ were sensitive to identified PG using a multinomial logistic regression relying on the following inputs: males (OR: 1.151, 95% CI: 1.042-1.272, P = 0.006), age ≥ 61 years (OR: 1.358, 95% CI: 1.188-1.553, P = 0.000), atrophic lesion (OR: 2.075, 95% CI: 1.870-2.302, P = 0.000), and H pylori infection (OR: 1.546, 95% CI: 1.368-1.748, P = 0.000). CONCLUSION:The essential characteristics of serum PG levels in Chinese are significantly skewed from the normal distribution, and influenced by age, sex, gastric mucosa lesions and H pylori infection. PGⅠ/Ⅱ ratio is more suitable for identifying subgroups with different influence factors compared with PGⅠor PGⅡ alone.

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Section: Discussionmentioning

confidence: 79%

Serum pepsinogen levels and their infl uencing factors: A population-based study in 6990 Chinese from North China

Sun¹

2007

WJG

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“…In this case, by way of example, two methods are considered for calculating the optimal cutpoint, namely, the method based on the Youden index, and the sensitivity-specificity equality criterion, since these are two of the best-known and most widely used methods in practice (Youden 1950;Greiner 1995;Aoki et al 1997;Shapiro 1999;Greiner et al 2000). If no adjustment is made for any categorical covariate, one is left with the default value of the categorical.cov argument: categorical.cov = NULL, and so there is no need for it to be indicated.…”

Section: Practical Application Of the Optimalcutpoints Packagementioning

confidence: 99%

OptimalCutpoints: AnRPackage for Selecting Optimal Cutpoints in Diagnostic Tests

López-Ratón¹,

et al. 2014

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Continuous diagnostic tests are often used for discriminating between healthy and diseased populations. For the clinical application of such tests, it is useful to select a cutpoint or discrimination value c that defines positive and negative test results. In general, individuals with a diagnostic test value of c or higher are classified as diseased. Several search strategies have been proposed for choosing optimal cutpoints in diagnostic tests, depending on the underlying reason for this choice. This paper introduces an R package, known as OptimalCutpoints, for selecting optimal cutpoints in diagnostic tests. It incorporates criteria that take the costs of the different diagnostic decisions into account, as well as the prevalence of the target disease and several methods based on measures of diagnostic test accuracy. Moreover, it enables optimal levels to be calculated according to levels of given (categorical) covariates. While the numerical output includes the optimal cutpoint values and associated accuracy measures with their confidence intervals, the graphical output includes the receiver operating characteristic (ROC) and predictive ROC curves. An illustration of the use of OptimalCutpoints is provided, using a real biomedical dataset.

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“…The ratio falls below 3.0 when AGC is advanced (AGC2+) [39]. It has been shown that the risk of GC is increased (5-fold) when the PGI/ PGII ratio is low [22,26,29,42,[45][46][47][48][49][50]. This test is intended as an additional diagnostic tool for AGC.…”

Section: Pepsinogen II (Pg Ii)mentioning

confidence: 99%

Serological Biomarker Panel (GastroPanel®): A Test for Non-Invasive Diagnosis of Dyspeptic Symptoms and for Comprehensive Detection of Helicobacter pylori Infection

Syrjänen¹

2017

Biomark J

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The two major risk factors of Gastric Cancer (GC) are Helicobacter pylori (HP) infection and Atrophic Gastritis (AG) It is currently possible to diagnose HP-infection and AG by using serological testing with a panel of biomarkers (GastroPanel ® , Biohit Oyj, Finland): Pepsinogen I (PGI), Pepsinogen II (PGII), and HP-antibodies. In this review, an introduction is made to the GastroPanel ® test as the first non-invasive diagnostic tool for: i) Dyspeptic symptoms, ii) Screening of asymptomatic subjects for the risks of GC, iii) A comprehensive diagnosis of HP-infection.GastroPanel ® test is based on stomach physiology both in health and disease. Accordingly, pepsinogen levels and their ratio is decreased in corpus atrophy (AGC), accompanied by elevated G-17b (basal) G-17b level also sensitively responds to gastric acid output, being low with high acid output and high when the stomach is acid-free (due to PPI-treatment or AGC) In Antrum Atrophy (AGA), G-17b is low and, importantly, does not respond to protein stimulation (G-17s), because the G-cells are disappeared.The results of GastroPanel ® test are interpreted by a special software (GastroSoft ® ) identifying 8 diagnostic marker profiles. Of those, four (profiles 1, 2, 3, and 8) represent purely functional disorders (of acid output), while three others specify structural abnormalities (profiles 5, 6, and 7 for AGC, AGA, and AGpan, respectively) the remaining (profile 4) is typical to HPinfection, with three possible outcomes: a) Active HPinfection, b) Successful eradication, and c) Failed eradication.GastroPanel ® test has been validated in both clinical and screening settings. The entire published literature was subjected to systematic review and meta-analysis, including 27 eligible studies that comprise almost 9.000 patients. GastroPanel ® was shown to perform better in diagnosis of AGC than AGA, with 70.2% vs. 51.6% pooled SE, and 93.9% vs. 84.1% pooled SP, respectively. This first meta-analysis corroborates the recently launched statement of 16 international experts, advocating the use of this non-invasive serological test as the first-line diagnostic tool for dyspeptic symptoms and for screening of the risks of GC among asymptomatic subjects.The two most commonly used HP tests (UBT and SAT) are prone to false-negative results in conditions with decreased bacterial loads in the stomach: 1) Use of PPI medication; 2) Use of antibiotics; 3) Bleeding peptic ulcer; 4) AG; 5) GC; 6) MALT lymphoma, and 7) Partial gastrostomy. False-positive results do occur in cases where urease-producing bacterial species are colonizing an acid-free stomach (AG or PPI users) it is mandatory that these serious limitations in the use of UBT and SAT are properly acknowledged while these two HP tests are being promoted. Given that this bacteria is the single most important risk factor of GC, it is time to move a step forward also in the diagnosis of HP-infections, and start using the test (GastroPanel ® ) that is: i) Free from the shortcoming of the conventional HP tests, an...

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Evaluation of Cutoff Levels for Screening of Gastric Cancer Using Serum Pepsinogens and Distributions of Levels of Serum Pepsinogen I, II and of PG I / PG II Ratios in a Gastric Cancer Case-Control Study

Cited by 43 publications

References 7 publications

Serum pepsinogen levels and their infl uencing factors: A population-based study in 6990 Chinese from North China

Serum pepsinogen levels and their infl uencing factors: A population-based study in 6990 Chinese from North China

OptimalCutpoints: AnRPackage for Selecting Optimal Cutpoints in Diagnostic Tests

Serological Biomarker Panel (GastroPanel®): A Test for Non-Invasive Diagnosis of Dyspeptic Symptoms and for Comprehensive Detection of Helicobacter pylori Infection

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