title: Serum pepsinogen levels can quantify the risk of development of metachronous gastric cancer after endoscopic resection.
abstract: We have previously reported that serum pepsinogen (PG) can quantify the level of gastric mucosal atrophy, and that H. pylori eradication reduces cancer development in subjects with mild atrophy identified by serum PG levels. The aim of this study was to elucidate the predictive ability of serum PG levels for the development of metachronous gastric cancer (MGC) after endoscopic resection (ER) of primary cancer in association with H. pylori eradication. A retrospective chart review was performed, and 330 patients who underwent ER for initial early gastric cancer were enrolled. Presence or absence of H. pylori, serum PG levels, and endoscopic atrophy at ER were evaluated. H. pylori eradication was performed at the patient's request after ER. The incidence of MGC in these patients was analyzed. Of 330 patients, 47 developed MGC. Endoscopic extensive atrophy was observed more frequently in patients with MGC (p = 0.001). Although PG I or PG II alone did not significantly differ according to development of MGC, the proportion of PG I/II ≤ 3.0, which is one of the criteria of PG test-positive, was significantly higher in patients with MGC (83 vs. 69%, p = 0.04). H. pylori eradication after ER did not affect MGC development (p = 0.2). On multivariate analysis, serum PG I/II ratio ≤ 3.3 was significantly associated with the development of MGC (hazard ratio: 3.66, 95% confidence interval: 1.47-12.25, p = 0.004). The risk of MGC after ER could be quantitatively predicted by the PG I/II ratio regardless of H. pylori status.
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Mikitaka
authors.initials: M
authors.lastname: Iguchi
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takeichi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Nakachi
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Fukatsu
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Mori
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Maeda
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Moribata
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Shingaki
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Niwa
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Deguchi
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Inoue
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Maekita
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
mesh_terms: D000368:Aged; D001284:Atrophy; D014408:Biomarkers, Tumor; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D020699:Gastroscopes; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D020116:Pepsinogen A / Q000097:blood*; D012306:Risk; D013274:Stomach Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D020116:Pepsinogen A
keywords: Helicobacter pylori; eradication; gastric atrophy; metachronous gastric cancer; serum pepsinogen