Varis K, Sipponen P, Laxén F, Samloff I M, Huttunen J K, Taylor P R, Heinonen O P, Albanes D, Sande N, Virtamo J, Härkönen M
National Public Health Institute, University of Helsinki, Finland.
Scand J Gastroenterol. 2000 Sep;35(9):950-6. doi: 10.1080/003655200750023011.
The risk of gastric cancer (GCA) is increased in atrophic gastritis. A low serum pepsinogen group I (SPGI) level is a good serologic indicator of atrophic gastritis of the gastric corpus and fundus, and can be used for diagnosis of subjects with atrophic gastritis and of increased risk for GCA. The present study was undertaken to investigate whether SPGI assay and a diagnostic gastroscopy could enable the diagnosis of GCA at an early stage.
The study was carried out as part of the Alpha-Tocopherol, Beta-Carotene Cancer prevention study (ATBC study) in Finland, in which 22,436 male smokers aged 50-69 years were screened by SPGI. Low SPGI levels (< 25 microg/l) were found in 2196 (9.8%) men. Upper GI endoscopy (gastroscopy) was performed in 1344 men (61%) and 78% of these had moderate or severe atrophic corpus gastritis in endoscopic biopsies. A control series of 136 men from the ATBC study cohort with abdominal symptoms, but with SPGI > or = 50 microg/l were similarly endoscopied, and 2.2% of these had corpus atrophy.
Neoplastic alterations were found in 63 (4.7%; 95% CI: 3.6%-5.8%) of the 1344 endoscopied men with low SPGI levels. Of these, 42 were definite dysplasias of low grade, 7 dysplasias of high grade, 11 invasive carcinomas, of which 7 were 'early' cancers, and 3 carcinoid tumors. In the control series, 1 man (0.7%) of the 136 men had a definite low-grade dysplasia. Thus, 18 (1.3%; 95% CI 0.7%-2.0%) cases with 'severe' neoplastic lesions (4 advanced cancers, 7 early cancers and 7 dysplasias of high grade) were found in the low SPGI group, but there were none in the control group. All four patients with advanced cancer died from the malignancy within 5 years (mean survival time 2.5 years), whereas surgical treatment in all those with early cancer or high-grade dysplasia was curative. One of the seven patients with early cancer and two of the seven with high-grade dysplasia died within 5 years, but none died from the gastric cancer. Thus, curative treatment was given to 14 of 18 men in whom a malignant lesion was found in gastroscopy. This is about 15% of all gastric cancer cases (92 cases) which were diagnosed within 5 years after SPGI screening in the 22,436 men. Among the gastric cancer cases of the main ATBC study, the 5-year survival rate was 33% (85% of the non-survivors died from gastric cancer).
We conclude that assay of SPGI followed by endoscopy is an approach which can enable the early diagnosis of gastric cancer at a curable stage.
萎缩性胃炎会增加患胃癌（GCA）的风险。血清胃蛋白酶原I（SPGI）水平低是胃体和胃底萎缩性胃炎的良好血清学指标，可用于诊断萎缩性胃炎患者及GCA风险增加的人群。本研究旨在探讨SPGI检测和诊断性胃镜检查能否早期诊断GCA。
该研究作为芬兰α-生育酚、β-胡萝卜素癌症预防研究（ATBC研究）的一部分进行，对22436名年龄在50 - 69岁的男性吸烟者进行了SPGI筛查。2196名（9.8%）男性SPGI水平低（< 25微克/升）。对1344名男性（61%）进行了上消化道内镜检查（胃镜检查），其中78%在内镜活检中有中度或重度胃体萎缩性胃炎。对ATBC研究队列中136名有腹部症状但SPGI≥50微克/升的男性作为对照组进行了类似的内镜检查，其中2.2%有胃体萎缩。
在1344名SPGI水平低的接受内镜检查的男性中，发现63例（4.7%；95%可信区间：3.6% - 5.8%）有肿瘤性改变。其中，42例为明确的低级别发育异常，7例为高级别发育异常，11例为浸润性癌，其中7例为“早期”癌症，3例为类癌肿瘤。在对照组中，136名男性中有1名（0.7%）有明确的低级别发育异常。因此，在SPGI低水平组中发现18例（1.3%；95%可信区间0.7% - 2.0%）有“严重”肿瘤性病变（4例进展期癌症、7例早期癌症和7例高级别发育异常），而对照组中无此类病例。所有4例进展期癌症患者均在5年内死于恶性肿瘤（平均生存时间2.5年），而所有早期癌症或高级别发育异常患者经手术治疗均治愈。7例早期癌症患者中有1例、7例高级别发育异常患者中有2例在5年内死亡，但均非死于胃癌。因此，在胃镜检查中发现有恶性病变的18名男性中有14名接受了治愈性治疗。这约占22436名男性中SPGI筛查后5年内诊断出的所有胃癌病例（92例）的15%。在主要的ATBC研究的胃癌病例中，5年生存率为33%（85%的非幸存者死于胃癌）。
我们得出结论，先进行SPGI检测再进行内镜检查是一种能够在可治愈阶段早期诊断胃癌的方法。
