Scoring model for discriminating gastric cancer risk in patients with negative serum pepsinogen and anti‐Helicobacter pylori antibody results

Abstract

Background The ABC test measures serum pepsinogen and anti‐Helicobacter pylori IgG antibody levels to predict precancerous conditions in the stomach and gastric cancer. However, a limitation of this test is that the gastric cancer risk is not negligible in patients with a negative result. Methods Based on their ABC results, 1157 patients were classified into Groups A (n = 392), B (n = 479), C (n = 247), and D (n = 39). In Group A, 24.2% of patients had atrophic gastritis and/or intestinal metaplasia and had thus been incorrectly assigned to Group A. Patients in Group A were then assigned to derivation (n = 236) and validation (n = 156) cohorts by 3:2 random sampling. Logistic regression analyses were performed to identify the factors discriminating between a correct (true) and incorrect (false) Group A classification. Results A 4‐point discriminative model was constructed based on a high‐negative H. pylori IgG antibody titer and the patient's age (50–64 and ≥65 years). The areas under the receiver operating characteristic curve for the derivation and validation cohorts were 0.868 and 0.894, respectively. In the validation cohort, the addition of a discriminative model score ≥2 to the ABC method showed a similar accuracy for predicting gastric cancer risk compared with the ABC method alone (93.8% vs. 92.4%). Conclusion The 4‐point discriminative model may help identify patients with a normal serological test who are nonetheless at risk of developing gastric cancer.

Comparison of different risk stratifications for gastric cancer and establishing a simplified risk‐scoring model based on the Kyoto classification

“…We are concerned that the lower‐than‐expected rate of Hp antibody may be due to a decrease in antibody titers in some patients after unintentional Hp eradication (antibiotic or proton‐pump inhibitor administration). This may also account for the lower‐than‐expected diagnostic efficacy of the Japanese scoring system, which has also received attention in previous study 24 …”

“…This may also account for the lower-thanexpected diagnostic efficacy of the Japanese scoring system, which has also received attention in previous study. 24 Despite revolutionary advances in endoscopic technology, there is no substitute for the role of WLE in recognition of EGC in primary hospitals. With increasing patient compliance, it is clear that endoscopy is a more accurate way to assess individual risk of EGC because it is less affected by recall bias and medication.…”