Risk of gastric cancer in asymptomatic, middle-aged Japanese subjects based on serum pepsinogen and Helicobacter pylori antibody levels.
A total of 5,209 asymptomatic, middle-aged subjects, whose serum pepsinogen (PG) and Helicobacter pylori antibody levels had been assessed, were followed for 10 years. Subjects with positive serum H. pylori antibodies (>50 U/mL) had an increased cancer risk (HR = 3.48, 95% CI = 1.26-9.64). Risk of gastric cancer increased as the antibody level increased; the H. pylori-positive group with antibody levels >500 U/mL had the highest incidence rate (325/100,000 person-years). Cancer development also increased with a reduced serum PG I level or a reduced PG I/II ratio; the risk was significantly elevated with serum PG I level <or=30 ng/mL (HR = 3.54, 95% CI = 1.95-6.40) or PG I/II ratio <or=3.0 (HR = 4.25, 95% CI = 2.47-7.32). Furthermore, the risk of diffuse-type cancer increased as PG II level increased; it was significantly elevated with PG II level >or=30 ng/mL (HR = 3.81, 95% CI = 1.10-13.21). Using H. pylori antibody and PG levels, subgroups with an especially high or low cancer incidence rate could be identified. H. pylori-negative or indeterminate subjects with low PG level (PG I <or=30 ng/mL or PG I/II ratio <or=2.0) or H. pylori-positive subjects with antibody levels >500 U/mL and a low PG level were among the subgroups with a high cancer incidence rate (over 400/100,000 person-years). In contrast, H. pylori-negative subjects with a PG I level >70 ng/mL or a PG I/II ratio >3.0 had the lowest risk; none of these subjects developed cancer. Thus, serum PG levels and/or H. pylori antibody levels can be used to predict the risk of cancer in individuals with H. pylori-related gastritis from the general population.
Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama-city, Wakayama 641-0012, Japan.
Kimihiko
K
Yanaoka
Masashi
M
Oka
Noriko
N
Yoshimura
Chizu
C
Mukoubayashi
Shotaro
S
Enomoto
Mikitaka
M
Iguchi
Hirohito
H
Magari
Hirotoshi
H
Utsunomiya
Hideyuki
H
Tamai
Kenji
K
Arii
Nobutake
N
Yamamichi
Mitsuhiro
M
Fujishiro
Tatsuya
T
Takeshita
Osamu
O
Mohara
Masao
M
Ichinose
D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood*; D015331:Cohort Studies; D016481:Helicobacter Infections / Q000097:blood* / Q000201:enzymology / Q000453:epidemiology*; D016480:Helicobacter pylori / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood*; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000097:blood* / Q000201:enzymology / Q000453:epidemiology* / Q000382:microbiology
D000907:Antibodies, Bacterial; D020116:Pepsinogen A