Abstract
BackgroundEarly-stage gastric cancer is mostly asymptomatic and can easily be missed easily by conventional gastroscopy. Currently, there are no useful biomarkers for the early detection of gastric cancer, and their identification of biomarkers is urgently needed.MethodsGastric juice was obtained from 185 subjects that were divided into three groups: non-neoplastic gastric disease (NGD), advanced gastric cancer and early gastric cancer (EGC). The levels of aromatic amino acids in the gastric juice were quantitated using high-performance liquid chromatography.ResultsThe median values (25th to 75th percentile) of tyrosine, phenylalanine and tryptophan in the gastric juice were 3.8 (1.7–7.5) µg/ml, 5.3 (2.3–9.9) µg/ml and 1.0 (0.4–2.8) µg/ml in NGD; 19.4 (5.8–72.4) µg/ml, 24.6 (11.5–73.7) µg/ml and 8.3 (2.1–28.0) µg/ml in EGC. Higher levels of tyrosine, phenylalanine and tryptophan in the gastric juice were observed in individuals of EGC groups compared those of the NGD group (NGD vs. EGC, P<0.0001). For the detection of EGC, the areas under the receiver operating characteristic curves (AUCs) of each biomarker were as follows: tyrosine, 0.790 [95% confidence interval (CI), 0.703–0.877]; phenylalanine, 0.831 (95% CI, 0.750–0.911); and tryptophan, 0.819 (95% CI, 0.739–0.900). The sensitivity and specificity of phenylalanine were 75.5% and 81.4%, respectively, for detection of EGC. A multiple logistic regression analysis showed that high levels of aromatic amino acids in the gastric juice were associated with gastric cancer (adjusted β coefficients ranged from 1.801 to 4.414, P<0.001).ConclusionIncreased levels of tyrosine, phenylalanine and tryptophan in the gastric juice samples were detected in the early phase of gastric carcinogenesis. Thus, tyrosine, phenylalanine and tryptophan in gastric juice could be used as biomarkers for the early detection of gastric cancer. A gastric juice analysis is an efficient, economical and convenient method for screening early gastric cancer development in the general population.
Highlights
Gastric cancer is the second most common type of cancer in East Asia, and the prognosis of gastric cancer patients is poor as a result of late detection [1,2,3]
Clinical Characteristics of Patients This study contained 185 patients separated into 3 groups: 70 neoplastic gastric disease (NGD) patients, 66 advanced gastric cancer (AGC) patients and 49 early gastric cancer (EGC) patients
An increase in the total protein content was observed in the gastric juice samples from the AGC and EGC groups relative to that of the NGD group (Dunn’s test, AGC vs. NGD, P,0.0001; EGC vs. NGD, P,0.0001) (Table 1)
Summary
Gastric cancer is the second most common type of cancer in East Asia, and the prognosis of gastric cancer patients is poor as a result of late detection [1,2,3]. Less than 5% of early gastric cancer cases are detected and diagnosed promptly [5]. Endoscopy followed by pathological biopsy is the preferred method to detect early gastric cancer (EGC). EGC is largely asymptomatic prior to the onset of severe symptoms, and an endoscopic investigation based on severe symptoms always delays the detection of stomach cancer. Population-based screening may facilitate the early detection and diagnosis of gastric cancer. Both the lack of experienced endoscopists and the patient discomfort associated with the procedure reduce the application of this method as a screening tool for EGC. Early-stage gastric cancer is mostly asymptomatic and can be missed by conventional gastroscopy. There are no useful biomarkers for the early detection of gastric cancer, and their identification of biomarkers is urgently needed
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