Serum pepsinogen accurately predicts gastric adenocarcinoma

Last Updated: 2015-03-27

By Will Boggs MD

NEW YORK (Reuters Health) - Serum pepsinogen levels can accurately predict which individuals will develop gastric adenocarcinoma, but this approach appears to be cost-effective only for current smokers, according to new research.

"Our model-based study suggests that a one-time screen with a serum pepsinogen test can reduce the risk of dying from gastric adenocarcinoma among 50-year old men who smoke," Dr. Jennifer M. Yeh from Harvard T. H. Chan School of Public Health in Boston, Massachusetts, told Reuters Health by email. "This one-time screen would not require routine measurement of pepsinogen levels, and therefore has the potential to be a high-value strategy."

Normal gastric mucosa progresses to invasive cancer through a series of precancerous lesions that produce less pepsinogen as they become atrophic or dysplastic.

Dr. Yeh's team used a decision-analytic simulation-based modeling approach to assess the potential clinical benefits and cost-effectiveness of serum-pepsinogen screening, endoscopic-based screening, and H. pylori screening to reduce intestinal-type non-cardia gastric adenocarcinoma (NCGA) incidence and mortality.

For purposes of the model, a positive serum pepsinogen screen for atrophy was defined as a serum-pepsinogen I level of 70 mcg/L or lower along with a pepsinogen I/II ratio of 3 or less. Positive screens were followed up by endoscopy with multiple random biopsies of the gastric mucosa.

For 20-year-old men, whose lifetime risk of intestinal-type NCGA is 0.24%, serum pepsinogen screening would reduce the lifetime risk by 26.4%, compared with reductions of 21.2% with endoscopic-based screening and 0.2% with H. pylori screening.

Targeting screening to 50-year-old male current smokers would reduce their estimated 0.35% lifetime risk by 30.8% with serum pepsinogen screening, 25.5% with endoscopy, and 0.1% with H. pylori screening.

Serum-pepsinogen screening of the general population would cost an estimated $105,400 per quality-adjusted life-year (QALY) gained, compared with no screening, the researchers report in Gut, online March 16.

But the costs per QALY vary greatly for current smokers ($76,000), former smokers ($94,500), and never smokers ($137,800).

"In countries where gastric cancer is a leading cause of cancer-related mortality, gastric cancer control efforts have focused on Helicobacter pylori screening or endoscopic-based gastric cancer screening," Dr. Yeh explained. "Our findings confirm that those strategies are unlikely to be cost-effective in the U.S., where gastric cancer is much less common."

"However," she said, "there are other secondary prevention strategies, such as a one-time serum-pepsinogen screen targeted to current smokers, that from a population perspective may be effective in reducing the number of deaths from gastric cancer in the U.S. and warrant consideration."

"Additional data on serum-pepsinogen test performance among U.S. populations are needed to confirm our model-based findings and should be a priority for future clinical studies," Dr. Yeh added.

The study did not receive commercial funding, and none of the authors reported a conflict of interest.

SOURCE: http://bit.ly/1Gxc6GD

Gut 2015.