title: Characteristics of gastric cancer in negative test of serum anti-Helicobacter pylori antibody and pepsinogen test: a multicenter study.
abstract: OBJECTIVE
  The serological risk prediction system combines the pepsinogen test and anti-Helicobacter pylori (H. pylori) antibody determination. In this system, chronic atrophic gastritis (CAG) is diagnosed using the pepsinogen test. Patients who are H. pylori negative and pepsinogen negative are classified into group A, are assumed to be H. pylori uninfected, and are at an extremely low risk for gastric cancer. However, gastric cancers are detected in this group. The aim of this study is to clarify the clinicopathological status of group A patients with gastric cancer.
  
  
  METHODS
  A total of 109 gastric cancer patients classified as group A were enrolled in a multicenter study. Group A patients were divided into two subgroups: group AN (H. pylori uninfected) and group AP (H. pylori infected). They were compared to 183 H. pylori-infected gastric cancer patients who were not in group A.
  
  
  RESULTS
  Of the 109 patients, only 7 were classified as group AN; the other 102 were classified as group AP. The clinicopathological features of group AP included older age, predominantly differentiated type cancer, endoscopically visualized CAG, and pepsinogen (PG) I/II ratio lower than that of group AN. In group AN, the depressed type was dominant, and the PG I/II ratio was higher than in those gastric cancer patients who were infected with H. pylori.
  
  
  CONCLUSIONS
  Patients in group AP had CAG, and their gastric cancers were similar to those of H. pylori-eradicated patients. Concerning the recent ABC classification system, advanced decision criteria should be proposed to decrease the false-negative evaluation of gastric cancer risk.
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Kiso
authors.affiliation: Health Service Center, Hiroshima University, Higashi-Hiroshima, Japan. myoshih@hiroshima-u.ac.jp.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Yoshihara
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of General Medicine, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Cancer Detection Center, Miyagi Cancer Society, Sendai, Japan.
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Kato
authors.affiliation: Department of General Medicine, Gastroenterology and Health-care, Japan Community Health-care Organization Shiga Hospital, Otsu, Japan.
authors.forename: Shigemi
authors.initials: S
authors.lastname: Nakajima
authors.affiliation: Department of Gastroenterology, National Hospital Organization Hakodate Hospital/Cancer Preventive Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Mabe
authors.affiliation: Department of Health Care Division, Kyoto Second Red Cross Hospital, Kyoto, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Gastroenterology, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
authors.affiliation: Department of Gastroenterology, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yada
authors.affiliation: Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Kawagoe, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Oka
authors.affiliation: Department of Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawai
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Boda
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kotachi
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Masuda
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood; D005188:False Negative Reactions; D005260:Female; D005757:Gastritis, Atrophic / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology*
chemical_list: D000907:Antibodies, Bacterial; D020116:Pepsinogen A
keywords: Gastric cancer; Gastritis; Helicobacter pylori; Pepsinogen; Serological risk prediction system