Park Chan Hyuk, Kim Eun Hye, Jung Da Hyun, Chung Hyunsoo, Park Jun Chul, Shin Sung Kwan, Lee Sang Kil, Lee Yong Chan
Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
Gastric Cancer. 2016 Jan;19(1):128-35. doi: 10.1007/s10120-015-0473-4. Epub 2015 Feb 8.
The ABCD screening method was developed for risk stratification of gastric cancer. It is unclear whether the ABCD method can predict the risk of gastric neoplasms, including gastric adenomas, as observed for gastric cancer. We aimed to devise a modified ABCD method for predicting gastric neoplasms.
We reviewed 562 patients who had undergone upper gastrointestinal tract endoscopy and whose serum IgG anti-Helicobacter pylori antibody, gastrin, and pepsinogen (PG) I and PG II data were available. Patients were classified into the following four groups: H. pylori antibody negative and normal PG level (group A), H. pylori antibody positive and normal PG level (group B), H. pylori antibody positive and low PG level (group C), and H. pylori antibody negative and low PG level (group D).
The PG I/PG II ratio was lower in patients with gastric neoplasms than in patients without these lesions (gastric adenoma vs gastric cancer vs no neoplasm, 3.7 ± 2.0 vs 3.8 ± 1.8 vs 4.9 ± 2.1, P < 0.001). The optimal cutoff values of the PG I/PG II ratio for predicting gastric neoplasms were 3.1 for H. pylori antibody negative patients and 4.1 for H. pylori antibody positive patients. A higher group grade was associated with a significantly higher proportion of gastric neoplasms [odds ratio (95 % confidence interval), group A, reference; group B, 1.783 (1.007-3.156); group C, 3.807 (2.382-6.085); and group D, 5.862 (2.427-14.155)].
The modified ABCD method using two different cutoff values according to the H. pylori antibody status was useful for predicting the presence of gastric neoplasms. This method might be a supplementary screening tool for both gastric adenoma and gastric cancer. However, further studies will be required to provide a definitive conclusion.
ABCD筛查方法是为胃癌风险分层而开发的。目前尚不清楚ABCD方法是否能像预测胃癌那样预测包括胃腺瘤在内的胃肿瘤风险。我们旨在设计一种改良的ABCD方法来预测胃肿瘤。
我们回顾了562例接受上消化道内镜检查且有血清IgG抗幽门螺杆菌抗体、胃泌素以及胃蛋白酶原（PG）I和PG II数据的患者。患者被分为以下四组：幽门螺杆菌抗体阴性且PG水平正常（A组）、幽门螺杆菌抗体阳性且PG水平正常（B组）、幽门螺杆菌抗体阳性且PG水平低（C组）以及幽门螺杆菌抗体阴性且PG水平低（D组）。
胃肿瘤患者的PG I/PG II比值低于无这些病变的患者（胃腺瘤与胃癌与无肿瘤，3.7±2.0 vs 3.8±1.8 vs 4.9±2.1，P<0.001）。预测胃肿瘤的PG I/PG II比值的最佳截断值，幽门螺杆菌抗体阴性患者为3.1，幽门螺杆菌抗体阳性患者为4.1。较高的分组等级与胃肿瘤的比例显著升高相关[比值比（95%置信区间），A组为参照组；B组，1.783（1.007 - 3.156）；C组，3.807（2.382 - 6.085）；D组，5.862（2.427 - 14.155）]。
根据幽门螺杆菌抗体状态使用两个不同截断值的改良ABCD方法有助于预测胃肿瘤的存在。该方法可能是胃腺瘤和胃癌的辅助筛查工具。然而，需要进一步研究以得出明确结论。
