The Significance of Low Serum Pepsinogen Levels to Detect Stomach Cancer Associated with Extensive Chronic Gastritis in Japanese Subjects

Miki, Kazumasa; Ichinose, Masakazu; Kawamura, Norio; Matsushima, Masashi; Ahmad, Haron Bin; Kimura, Miwako; Sano, Junko; Tashiro, Takao; Kakei, Nobuyuki; Oka, Hiroshi; Furihata, Chie; Takahashi, Kenji

doi:10.1111/j.1349-7006.1989.tb02276.x

Cited by 98 publications

(78 citation statements)

References 15 publications

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“…It is simple and inexpensive, and there is no radiation hazard. Early studies from Japan have shown that the serum pepsinogen I level was significantly lower in gastric cancer patients than in normal controls [8,16]. In contrast, no difference was found in serum pepsinogen II levels between the two groups.…”

Section: Discussionmentioning

confidence: 90%

Serum pepsinogen levels in gastric cancer patients and their relationship with Helicobacter pylori infection: a prospective study

Yeoh

Moochala

et al. 2002

Gastric Cancer

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Section: Discussionmentioning

confidence: 90%

Serum pepsinogen levels in gastric cancer patients and their relationship with Helicobacter pylori infection: a prospective study

Yeoh

Moochala

et al. 2002

Gastric Cancer

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“…The single use of pepsinogen tests is by no means sufficient for stomach cancer screening; however, it provides a valuable measure for selecting a population that needs further screening with endoscopy [12][13][14][15]. Serum pepsinogen was introduced for cancer screening to identify individuals with extensive atrophic gastritis [16].…”

Section: Discussionmentioning

confidence: 99%

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

Agkoc

Dursun

Albayrak

et al. 2010

EAJM

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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.

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“…2,39,46,57,69 Authors focused mainly on the diagnosis of atrophy, as its relation with gastric cancer has been reported. If in most Western countries the focus was on the identification of individuals for intervention studies, in Japan, its use was meant to identify those for endoscopic examination, and for the diagnosis of gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

“…1 It is generally accepted that serum pepsinogen concentrations are related to gastric mucosal lesions, and particularly to chronic atrophic gastritis (CAG). 2,3 At least for intestinal-type gastric carcinoma, CAG is considered to be a preceding condition in the sequential histopathological changes that lead to cancer. 4,5 Pepsinogen has therefore been used as a serological biopsy for more than 20 years in different countries and sets of patients.…”

mentioning

confidence: 99%

Meta-analysis on the validity of pepsinogen test for gastric carcinoma, dysplasia or chronic atrophic gastritis screening

Dinis-Ribeiro

Yamaki

Miki³

et al. 2004

J Med Screen

183

154

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Aim:To assess the validity of the measurement of pepsinogen I and II as a screening test for gastric cancer and pre-malignant lesions, namely low-grade dysplasia, both in the general population and in selected groups of patients. Methods:A meta-analysis of sensitivity and specificity results from individual papers on the use of the pepsinogen test. An intrinsic cut-off effect was assumed and a random effect model was used for pooling.Results: Forty-two data sets were included: 27 (64%) population-based screening studies (n=296,553) and 15 (36%) sets of selected individuals (n=4385). Homogenous sensitivity and diagnostic odds ratio (DOR) estimates were found in studies using both pepsinogen I levels and pepsinogen I/II ratio calculations. Pooled pairs of sensitivity and false positive rates (FPr) for pepsinogen I ≤70; pepsinogen I/II ratio ≤3, pepsinogen I ≤50; pepsinogen I/II ratio ≤3, and pepsinogen I ≤30; pepsinogen I/II ratio ≤2, were sensitivity 77%/FPr 27%, sensitivity 68%/FPr 31%, and sensitivity 52%/FPr 84%, respectively. Positive predictive values (PPV) varied between 0.77% and 1.25%, and negative predictive values (NPV) varied between 99.08% and 99.90%. In selected groups, pooling was only possible when considering pepsinogen I ≤70; pepsinogen I/II ratio ≤3: giving sensitivity 57%, specificity 80%, PPV 15% and NPV 83%. As for the diagnosis of dysplasia, studies considering pepsinogen I <50; pepsinogen I/II ratio <3 obtained sensitivity 65% and specificity ranging from 74%-85%, both with NPV >95%. Conclusion:Pepsinogen test definition should include pepsinogen I/II ratio as consistency was obtained, both in population based studies and in selected groups for those studies that used pepsinogen I serum levels together with pepsinogen I/II ratio for screening for gastric cancer in highincidence regions other than Japan. Further studies of this test in the management of high-risk patients seem to be worthwhile.

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The Significance of Low Serum Pepsinogen Levels to Detect Stomach Cancer Associated with Extensive Chronic Gastritis in Japanese Subjects

Cited by 98 publications

References 15 publications

Serum pepsinogen levels in gastric cancer patients and their relationship with Helicobacter pylori infection: a prospective study

Serum pepsinogen levels in gastric cancer patients and their relationship with Helicobacter pylori infection: a prospective study

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

Meta-analysis on the validity of pepsinogen test for gastric carcinoma, dysplasia or chronic atrophic gastritis screening

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