Serum pepsinogen level may help predict death from gastric cancer

Last Updated: 2018-02-22

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Serum pepsinogen (PG) level appears to be a useful biomarker in predicting risk for death from gastric cancer, according to research from Taiwan.

"A low serum PG-I level and/or a low PG-I/II ratio were predictive of a higher risk of gastric cancer death among participants in this long-term population-based cohort, which supported the value of using this serological biomarker to identify high-risk participants for endoscopic detection of early gastric cancer," the authors write in Journal of Clinical Gastroenterology, online January 23.

"Pepsinogen testing can reflect the severity of atrophic changes in the stomach mucosa. Individuals who test positive have a 3- to 4-fold increase of stomach cancer risk. This is the most reliable marker for stomach cancer available now," coauthor Dr. Yi-Chia Lee of National Taiwan University Hospital, No. 7, in Taipei, told Reuters Health by email.

Between 1995 and 1998, the researchers conducted a population-based screening program for gastric cancer among residents over age 30 in the Matsu Islands, which are part of Taiwan. Of the 3,514 study participants, 1,682 (47.9%) were screened for serum PG levels. Those who tested positive were also given upper endoscopy. The program monitored gastric cancer death through the end of 2010.

In the Matsu Islands, mass screening and treatment for Helicobacter pylori infection, a risk factor for gastric cancer, began in 2004. No such screening program had existed on the islands previously.

During 16 years of follow-up, 14 deaths from gastric cancer were recorded. In multivariate analyses adjusted for age, sex, and H. pylori positivity, PG-I <30 micrograms/liter and either PG-I <30 micrograms/liter or PG-I/II ratio <3 were significantly linked with risk of gastric cancer death (hazard ratios, 3.27 and 3.45, respectively). By contrast, no significant links between PG level and other causes of death were found.

"Eradication of the H. pylori in stomach is now the first step to preventing stomach cancer. However, after eradication, some individuals still have residual risk of stomach cancer because the molecular damage in the stomach may have become irreversible. Patients who test positive may need periodic upper endoscopic screening," Dr. Lee advised.

"These findings may help primary care physicians and patients understand how healthy the stomach is and how high the cancer risk is. The serological test is simple, rapid, and noninvasive, so it can be easily applied in the clinical practice," he noted.

"However, I feel that there is still room to improve the predictability, because some gastric cancers may develop through a different pathway (not through the inflammation-atrophic pathway), and PG cannot predict them well," he added.

Dr. Michael McNamara, a medical oncologist at Cleveland Clinic in Ohio, told Reuters Health by email, "When upper gastrointestinal tract cancers are found after a patient has presented with symptoms, the disease is usually advanced and the likelihood of offering a curative therapy is low. Therefore, effective prevention and screening strategies would be helpful in reducing the mortality rates from these cancers."

Screening has successfully helped prevent gastric cancer, but with caveats, said Dr. McNamara, who was not involved in the study.

"Gastric cancer is often a result of chronic gastritis initiated by the presence of H. pylori, and eradication of H. pylori infection appears to reduce gastric cancer risk. In high-incidence countries, screening for early cancers in asymptomatic patients is commonly performed and includes contrast radiography and/or upper endoscopy," he explained.

"There remains, however, considerable debate as to the relative benefits, costs, and harms of prevention and screening. This is significantly influenced by the incidence rates of gastric cancer and the medical resources of the country in question," he said.

"While this testing may eventually be used in high-risk areas, most gastric cancers in low-risk areas are actually found in the gastric cardia/gastroesphageal junction or are the 'diffuse type.' These cancers are not really related to H. pylori/atrophic gastritis, and pepsinogen testing would not be helpful in this group. For physicians in low-incidence regions (Western countries), these results are not very useful," Dr. McNamara advised. "Also, many patients in low-incidence areas are on proton-pump inhibitors, which may affect the pepsinogen level, making testing less accurate."

SOURCE: http://bit.ly/2BVi4qs

J Clin Gastroenterol 2018.