Prediction of Gastric Cancer Development by Serum Pepsinogen Test and Helicobacter pylori Seropositivity in Eastern Asians: A Systematic Review and Meta-Analysis

Abstract

BackgroundTo identify high-risk groups for gastric cancer in presumptively healthy populations, several studies have investigated the predictive ability of the pepsinogen test, H. Pylori antibodies, and a risk-prediction model based on these two tests. To investigate whether these tests accurately predict gastric cancer development, we conducted a systematic review and meta-analysis.MethodsPubMed and other electronic databases were searched for cohort studies published in English or Japanese from January 1985 through December 2013. Six reviewers identified eligible studies, and at least two investigators extracted data on population and study-design characteristics, quality items, and outcomes of interest. Meta-analyses were performed on non-overlapping studies.ResultsNine prospective cohorts from Eastern Asia reported in 12 publications, including 33,741 asymptomatic middle-aged participants of gastric cancer screening, were eligible. For discriminating between asymptomatic adults at high and low risk of gastric cancer, the pepsinogen test (summary hazard ratio [HR], 3.5; 95% confidence interval [CI], 2.7–4.7; I2 = 0%) and H. pylori antibodies (summary HR, 3.2; 95% CI, 2.0–5.2; I2 = 0%) were statistically significant predictors as standalone tests. Although the risk-prediction model was in general moderately accurate in separating asymptomatic adults into four risk groups (summary c-statistic, 0.71; 95% CI: 0.68–0.73; I2 = 7%), calibration seemed to be poor. The study validity was generally limited.ConclusionsThe serum pepsinogen test, H. pylori antibodies, and the four-risk-group model for predicting gastric cancer development seem to have the potential to stratify middle-aged presumptively healthy adults. Future research needs to focus on comparative studies to evaluate the impact of screening programs adopting these tests. Also, validation, preferably with model updating, is necessary to see whether the current model performance is transferable to different populations.

Helicobacter pylori Infection, Gastric Cancer and Gastropanel

“…Another study based on 3328 participants concluded that a combination of serum PG levels and H. pylori antibody test is useful for detecting gastric neoplasms based on Correa's cascade, with a slow gastric carcinogenesis pathway progressing from gastric adenoma with low grade dysplasia to Lauren's intestinaltype GC. The sensitivity and specificity of these two biomarkers have been reported to be 90-95% and 84.6-89.7%, respectively [13].…”

Characteristics of gastric cancer in negative test of serum anti-Helicobacter pylori antibody and pepsinogen test: a multicenter study

“…pylori antibody-positive/PG-positive subjects in group C, and anti-H. pylori antibody-negative/PG-positive subjects were in group D. Specifically, multivariate meta-analyses suggested that group A had a lower risk than groups B/C/D and that group B had a lower risk compared with groups C/D [10].…”

“…PG concentrations have been used with a set of recommended cutoff values to diagnose chronic atrophic gastritis (CAG) (PG I B 70 ng/ml and PG I/II B 3.0 ng/ml) [7]. Therefore, gastric cancer risk can be evaluated by measuring the serum anti-H. pylori antibody titer in combination with PG levels [8][9][10], and this system of risk prediction using the anti-H. pylori antibody serological test and the PG test is known as the ABC classification system in Japan [8][9][10]. Subjects with negative test results for either the anti-H. pylori antibody serology test or the PG test were classified in group A, anti-H. pylori antibodypositive/PG-negative subjects were in group B, anti-H.…”

Cutoff Pepsinogen Level for Predicting Unintendedly Eradicated Cases of <b><i>Helicobacter pylori</i></b> Infection in Subjects with Seemingly Normal Pepsinogen Levels

“…In most cases, a positive result for serum H. pylori antibody indicates current H. pylori infection. Thus, a gastric cancer screening method using serum anti- H. pylori antibody and PG tests has been applied in some health check-up settings in Japan for screening high risk subjects of gastric cancer, and the method is called as the “ABC method” [6,7,8,11,12]. …”