Abstract
BackgroundThere is little information regarding whether the combination of Helicobacter pylori (H. pylori) antibody and serum pepsinogen (sPG), which is a marker of the degree of atrophic gastritis, has a discriminatory ability for detecting incident gastric cancer. We examined this issue in a long-term prospective cohort study of a Japanese population.MethodsA total of 2446 Japanese community-dwelling individuals aged ≥40 years were stratified into four groups according to baseline H. pylori serological status and sPG: Group A (H. pylori[−], sPG[−]), Group B (H. pylori[+], sPG[−]), Group C (H. pylori[+], sPG[+]), and Group D (H. pylori[−], sPG[+]), and participants were followed up prospectively for 20 years.ResultsDuring the follow-up, 123 subjects developed gastric cancer. Compared with that in Group A, the cumulative incidence of gastric cancer was significantly increased in Groups B, C, and D, whereas no significant difference was found between Groups C and D. The multivariable-adjusted risk of gastric cancer was significantly increased in Group B (hazard ratio [HR], 4.08; 95% confidence interval [CI], 1.62–10.28) and in Groups C and D combined (HR 11.1; 95% CI, 4.45–27.46). When the multivariable model with H. pylori antibody was changed into that with the combination of H. pylori antibody and sPG, the C statistics for developing gastric cancer increased significantly (0.773 vs 0.732, P = 0.005), and the continuous net reclassification improvement value was 0.591 (P < 0.001).ConclusionsOur findings suggest that the combination of H. pylori antibody and sPG is a useful tool for predicting the development of gastric cancer.
Highlights
Some prospective studies have shown that the combination of H. pylori antibody and serum pepsinogen (sPG) was significantly associated with the development of gastric cancer,[18,19,20,21] the follow-up period of these studies was relatively short, and no study has examined whether this method serves as a more useful tool for predicting gastric cancer than the measurement of H. pylori antibody alone
Adjusted incidence rate and hazard ratio with 95% confidence interval for gastric cancer according to the combination of Helicobacter pylori antibody and serum pepsinogen
We demonstrated that high-risk status based on risk stratification using the combination of H. pylori antibody and sPG was significantly associated with the occurrence of gastric cancer
Summary
Helicobacter pylori (H. pylori), which was discovered in 1983, is known to be a strong and convincing risk factor for the development of gastric cancer.[1,2,3,4] Long-term H. pylori infection causes chronic atrophic gastritis and gastric mucosal atrophy, which have been recognized as precursors of gastric cancer based on clinicopathologic and epidemiologic studies.[5,6,7,8] Both H. pylori infection and chronic atrophic gastritis have been detected with blood tests by assaying serum anti-H. pylori IgG9 and serum pepsinogen (sPG) levels,[10,11] and it has been reported that each of these conditions was a predictive marker for the development of gastric cancer.[2,12,13,14,15] it is known that antibody toRisk Stratification Tool for Gastric Cancer DevelopmentH. pylori is diminished due to severe atrophic gastritis,[16] and tests for sPG are negative when atrophic gastritis does not occur despite the existence of H. pylori infection.[17]. There is little information regarding whether the combination of Helicobacter pylori (H. pylori) antibody and serum pepsinogen (sPG), which is a marker of the degree of atrophic gastritis, has a discriminatory ability for detecting incident gastric cancer. We examined this issue in a long-term prospective cohort study of a Japanese population. When the multivariable model with H. pylori antibody was changed into that with the combination of H. pylori antibody and sPG, the C statistics for developing gastric cancer increased significantly (0.773 vs 0.732, P = 0.005), and the continuous net reclassification improvement value was 0.591 (P < 0.001). Conclusions: Our findings suggest that the combination of H. pylori antibody and sPG is a useful tool for predicting the development of gastric cancer
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