Abstract
BackgroundChronic Helicobacter pylori infection plays a central role in the development of gastric cancer as shown by biological and epidemiological studies. The H. pylori antibody and serum pepsinogen (PG) tests have been anticipated to predict gastric cancer development.MethodsWe determined the predictive sensitivity and specificity of gastric cancer development using these tests. Receiver operating characteristic analysis was performed, and areas under the curve were estimated. The predictive sensitivity and specificity of gastric cancer development were compared among single tests and combined methods using serum pepsinogen and H. pylori antibody tests.ResultsFrom a large-scale population-based cohort of over 100,000 subjects followed between 1990 and 2004, 497 gastric cancer subjects and 497 matched healthy controls were chosen. The predictive sensitivity and specificity were low in all single tests and combination methods. The highest predictive sensitivity and specificity were obtained for the serum PG I/II ratio. The optimal PG I/II cut-off values were 2.5 and 3.0. At a PG I/II cut-off value of 3.0, the sensitivity was 86.9% and the specificity was 39.8%. Even if three biomarkers were combined, the sensitivity was 97.2% and the specificity was 21.1% when the cut-off values were 3.0 for PG I/II, 70 ng/mL for PG I, and 10.0 U/mL for H. pylori antibody.ConclusionsThe predictive accuracy of gastric cancer development was low with the serum pepsinogen and H. pylori antibody tests even if these tests were combined. To adopt these biomarkers for gastric cancer screening, a high specificity is required. When these tests are adopted for gastric cancer screening, they should be carefully interpreted with a clear understanding of their limitations.
Highlights
Chronic Helicobacter pylori infection plays a central role in the development of gastric cancer as shown by biological and epidemiological studies
Charvat et al developed a prediction model for gastric cancer based on H. pylori infection and gastric atrophy with the risk factors related to lifestyle [18]
We evaluated the predictive sensitivity and specificity of the H. pylori antibody and serum PG tests for predicting gastric cancer development by Receiver operating characteristic (ROC) analysis based on a long follow-up period
Summary
Chronic Helicobacter pylori infection plays a central role in the development of gastric cancer as shown by biological and epidemiological studies. Chronic H. pylori infection plays a central role in the development of gastric cancer as shown by biological and epidemiological studies [4]. Charvat et al developed a prediction model for gastric cancer based on H. pylori infection and gastric atrophy with the risk factors related to lifestyle [18]. The strong association between gastric cancer and these risk factors suggested a high possibility of predicting gastric cancer incidence in the high-risk group detected by the serum PG and H. pylori antibody tests. If the future risk for gastric cancer development can be optimally clarified, appropriate preventive measures can be taken according to individual risks. These preventive measures can be made more efficient for gastric cancer screening to accurately target cancer screening subjects and decrease the screening frequency of the low-risk group These results are not directly connected with primary cancer screening. To adopt these biomarkers in gastric cancer screening, both sensitivity and specificity should be assessed considering the balance of benefits and harms
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