Comparison of the validity of three biomarkers for gastric cancer screening: carcinoembryonic antigen, pepsinogens, and high sensitive C-reactive protein.
OBJECTIVE
To identify a desirable serum marker for screening tools for gastric cancer, we evaluated the validity of 3 biomarkers, namely, carcinoembryonic antigen (CEA), pepsinogens (PGs), and high sensitive C-reactive protein (hsCRP).


METHODS
We estimated the mean serum levels of CEA, PGs, and hsCRP and compared the sensitivity and specificity of these 3 biomarkers in 378 subjects who were classified into 7 groups: normal, chronic atrophic gastritis, intestinal metaplasia, adenoma, early gastric cancer (EGC), advanced gastric cancer (AGC) without metastasis, and AGC with metastasis (M1).


RESULTS
There were no significant differences among the normal, high-risk (chronic atrophic gastritis, intestinal metaplasia, and adenoma), and EGC groups for CEA and hsCRP. However, the levels of CEA were relatively higher in the AGC group with intestinal-type cancer (P<0.01). Likewise, hsCRP was relatively higher in the AGC group with diffuse-type cancer (P<0.01). For the PG I/II ratio, there was no significant difference among the normal, high-risk, and cancer groups, including EGC (P<0.01). In addition, there was a negative correlation with grades (gammas=-0.480, P<0.01). However, the PG I/II ratio was relatively less effective in diffuse-type cancer compared with intestinal-type cancer. The combination of serum hsCRP and the PG I/II ratio had a higher sensitivity (77%) than did the PG I/II ratio alone (61%) in diffuse-type cancers.


CONCLUSIONS
The combination of serum hsCRP and PG I/II ratio would be helpful as a screening tool for gastric cancer in high incidence populations and may help to select high-risk subjects in need of further specific invasive screening tools such as endoscopy.
Chung
Hye Won
HW
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Kim
Ju Won
JW
Lee
Jong-Han
JH
Song
Si Young
SY
Chung
Jae Bock
JB
Kwon
Oh Hun
OH
Lim
Jong-Baeck
JB
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010435:Pepsinogens / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology
D015415:Biomarkers; D002272:Carcinoembryonic Antigen; D010435:Pepsinogens; D002097:C-Reactive Protein