title: Optimal cutoff value of the serum pepsinogen level for prediction of gastric cancer incidence: the Hisayama Study.
abstract: BACKGROUND
  Serum pepsinogen (sPG) levels have been established as a good marker of chronic atrophic gastritis and the sequential occurrence of gastric cancer. However, there have been few prospective investigations which investigated the predictive performance of sPG for future gastric cancer incidence.
  
  
  METHODS
  We prospectively followed-up a total of 2446 community-dwelling Japanese aged ≥ 40 years for 10 years and used the Youden's index to determine the cutoff values of the pepsinogen I level and pepsinogen I/II ratio to accurately discriminate gastric cancer events. Predictive performance of sPG was assessed by ROC curve.
  
  
  RESULTS
  During the follow-up, 69 subjects developed gastric cancer. The most predictive sPG test criteria were determined to be a pepsinogen I level ≤ 59 ng/ml and pepsinogen I/II ratio ≤ 3.9. The sensitivity and specificity of these criteria to discriminate the actual occurrence of gastric cancer were 71.0% and 69.2%, respectively. The area under the ROC curve for gastric cancer occurrence increased significantly by adding the sPG test to the model that included the status of Helicobater pylori infection and other potential risk factors (from 0.742 to 0.809; p for difference in the area < 0.001).
  
  
  CONCLUSIONS
  This study determined the optimal sPG test criteria for predicting gastric cancer occurrence over 10 years in a general Japanese population. These criteria would be effective to screen for individuals at high risk of this disease.
authors.affiliation: Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shikata
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Koji
authors.initials: K
authors.lastname: Yonemoto
authors.forename: Fumie
authors.initials: F
authors.lastname: Ikeda
authors.forename: Jun
authors.initials: J
authors.lastname: Hata
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Doi
authors.forename: Masayo
authors.initials: M
authors.lastname: Fukuhara
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Iida
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kiyohara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood*; D020115:Pepsinogen C / Q000097:blood*; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D014408:Biomarkers, Tumor; D020115:Pepsinogen C; D020116:Pepsinogen A