Serum pepsinogen level, atrophic gastritis and the risk of incident pancreatic cancer--a prospective cohort study.
BACKGROUND
Pancreatic cancer is a highly fatal disease without screening tests. Studies have suggested possible etiologic similarities between gastric and pancreatic cancers. Atrophic gastritis, a pre-malignant condition for gastric cancer, is characterized by low serum pepsinogen I (SPGI) level. We hypothesized that low SPGI level may be associated with an increased risk of pancreatic cancer and be a useful biomarker for the disease.


METHODS
Our analytic cohort included 20,962 participants in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC) who had SPGI level measured. Of these, 1663 (7.9%) subjects had low SPGI levels (<25 microg/l) and were invited for gastroscopy which was completed in 1059 (63.7%) participants. Atrophic gastritis was histologically confirmed in 1006 (95.0%) subjects. We used Cox proportional hazards regression to calculate the hazard ratios (HR) and 95% confidence intervals (CI) for pancreatic cancer.


RESULTS
During follow-up of up to 16.3 years (mean=10.8 years; 226,325 person-years), 227 incident pancreatic cancers were diagnosed. The incidence rates were 9.9, 11.3, and 12.7 per 10,000 person-years of follow-up for participants with normal pepsinogen level (> or = 25 microg/l), low pepsinogen level and histologically confirmed atrophic gastritis, respectively. Compared to subjects with normal pepsinogen levels, there was no statistically significant increased risk of pancreatic cancer among subjects with low pepsinogen level (adjusted HR=1.01; 95% CI: 0.63-1.62) or those with histologically confirmed atrophic gastritis (adjusted HR=1.13; 95% CI: 0.66-1.95).


CONCLUSIONS
Atrophic gastritis, serological or histological, is not associated with increased risk of pancreatic cancer. These findings do not provide any evidence for potential usefulness of SPGI for pancreatic cancer screening.
Cancer Prevention Fellowship Program, Office of Preventive Oncology, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD 20892, USA. laiyemoa@mail.nih.gov
Adeyinka O
AO
Laiyemo
Farin
F
Kamangar
Pamela M
PM
Marcus
Philip R
PR
Taylor
Jarmo
J
Virtamo
Demetrius
D
Albanes
Rachael Z
RZ
Stolzenberg-Solomon
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D015331:Cohort Studies; D005757:Gastritis, Atrophic / Q000097:blood*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000453:epidemiology; D020116:Pepsinogen A / Q000097:blood*; D011230:Precancerous Conditions / Q000097:blood*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D014408:Biomarkers, Tumor; D020116:Pepsinogen A