title: Cancer high-risk subjects identified by serum pepsinogen tests: outcomes after 10-year follow-up in asymptomatic middle-aged males.
abstract: BACKGROUND
  Gastric cancer screening using the pepsinogen filter test is receiving wide recognition in Japan owing to convenience, freedom from discomfort or risk, efficiency, and economy. Because the long-term outcomes of cancer development in extensive atrophic gastritis detected by pepsinogen test are unclear, test-positive and test-negative subjects were investigated in a longitudinal cohort study.
  
  
  METHODS
  Subjects comprised 5,209 middle-aged men with measured serum pepsinogen levels who were followed for 10 years. Cancer development based on "atrophy-positive" and "atrophy-negative" criteria used for cancer screening was investigated.
  
  
  RESULTS
  During the study, 63 cases of cancer developed in the cohort, representing an incidence rate of 125 per 100,000 person-years. Pepsinogen test screening using the most widely used atrophy-positive criterion (pepsinogen I, < or =70 ng/mL; pepsinogen I/II ratio, < or =3.0) displayed 58.7% sensitivity, 73.4% specificity, and 2.6% positive predictive value. Cancer incidence rate was 276 per 100,000 person-years for the atrophy-positive group and 70 per 100,000 person-years for the atrophy-negative group. Incidence rate was higher in groups fulfilling stricter positive criteria detecting more extensive atrophy, reaching 424 per 100,000 person-years. In addition, 9.2% of atrophy-negative subjects with pepsinogen I of >70 ng/mL and pepsinogen I/II ratio of < or =3.0 (reflecting putative inflammation-based high pepsinogen II level) are at high risk for cancer, particularly diffuse-type cancer, with a cancer incidence rate comparable with atrophy-positive subjects (216 per 100,000 person-years).
  
  
  CONCLUSIONS
  Atrophy-positive subjects by pepsinogen filter test, particularly those fulfilling stricter criteria, and atrophy-negative subjects with low pepsinogen I/II ratio reflecting putative extensive active inflammation constitute populations at high risk for gastric cancer, requiring thorough endoscopic examination.
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Yanaoka
authors.forename: Masashi
authors.initials: M
authors.lastname: Oka
authors.forename: Chizu
authors.initials: C
authors.lastname: Mukoubayashi
authors.forename: Noriko
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Shotaro
authors.initials: S
authors.lastname: Enomoto
authors.forename: Mikitaka
authors.initials: M
authors.lastname: Iguchi
authors.forename: Hirohito
authors.initials: H
authors.lastname: Magari
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Utsunomiya
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.forename: Kenji
authors.initials: K
authors.lastname: Arii
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohata
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Takeshita
authors.forename: Osamu
authors.initials: O
authors.lastname: Mohara
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
mesh_terms: D000328:Adult; D001284:Atrophy / Q000145:classification; D014408:Biomarkers, Tumor; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; D020116:Pepsinogen A