Povoa do Varzim, Vila do Conde Hospital, Porto, Portugal.
Eur J Gastroenterol Hepatol. 2012 Jan;24(1):37-41. doi: 10.1097/MEG.0b013e32834d0a0a.
To estimate the adherence of Western individuals to serum pepsinogen (PG) test and its accuracy in the detection of gastric cancer followed by upper gastrointestinal endoscopy.
Individuals from the northern region of Portugal, aged between 40 and 79 years, were invited to participate in a blood collection for the determination of serum PG values by ELISA method (Biohit kits). Participants were classified into two groups: positive (PG I ≤70 ng/ml and PG I/ PGII ≤3) and negative (all others). All participants with a positive test and a consecutive random sample of participants with a negative test were subjected to endoscopy with biopsy. All the participants (positive or negative) subjected to endoscopy were followed up over 5 years.
From a total of 13 118 participants, 5326 were men (41%) with a median age of 60 years, and 446 (3.4%) had a positive test. Of these, 274 (61%) were subjected to endoscopy. We observed six gastric cancers, five intestinal and one diffuse type, and three early gastric cancers, representing one cancer per approximately 2200 PG tests or one cancer per 74 positive tests. From these 240 participants with a negative test, three patients with gastric cancer were diagnosed during follow-up (an estimated negative predictive value of 99%). In this study, the PG test showed an estimated sensitivity, specificity, positive predictive value, and negative predictive value of 67, 47, 2, and 99%, respectively.
Inhabitants of this high-risk region showed good adherence rate to a gastric cancer detection program based on a PG test followed by upper gastrointestinal endoscopy implemented for the first time. Accuracy estimates were similar to those in Japanese reports, indicating that this methodology could also be used effectively in Western countries with high rates of gastric cancer. Further formal cost-effective studies are however needed.
评估西方个体对血清胃蛋白酶原（PG）检测的依从性及其在上消化道内镜检查后检测胃癌的准确性。
邀请葡萄牙北部地区年龄在 40 岁至 79 岁之间的个体参加血液采集，以通过 ELISA 方法（Biohit 试剂盒）测定血清 PG 值。参与者分为两组：阳性（PG I≤70ng/ml 和 PG I/PGII≤3）和阴性（其他所有情况）。所有阳性检测者和随后随机选择的阴性检测者均进行内镜检查和活检。所有接受内镜检查的参与者（阳性或阴性）均进行了为期 5 年的随访。
在总共 13118 名参与者中，有 5326 名男性（41%），中位年龄为 60 岁，446 名（3.4%）检测结果为阳性。其中，274 名（61%）进行了内镜检查。我们观察到 6 例胃癌，5 例肠型和 1 例弥漫型，3 例为早期胃癌，每约 2200 次 PG 检测或每 74 次阳性检测就会发现 1 例癌症。在这 240 名阴性检测者中，有 3 名患者在随访期间被诊断出患有胃癌（阴性预测值估计为 99%）。在这项研究中，PG 检测的估计敏感性、特异性、阳性预测值和阴性预测值分别为 67%、47%、2%和 99%。
在这个高风险地区，首次实施基于 PG 检测的胃癌检测计划并进行上消化道内镜检查，居民的依从性良好。准确性估计与日本的报告相似，表明这种方法也可以在胃癌发病率较高的西方国家有效使用。然而，需要进一步进行正式的成本效益研究。
