Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan.
Health Service Center, Hiroshima University, Higashi-Hiroshima, Japan.
Gastric Cancer. 2017 Sep;20(5):764-771. doi: 10.1007/s10120-016-0682-5. Epub 2016 Dec 26.
The serological risk prediction system combines the pepsinogen test and anti-Helicobacter pylori (H. pylori) antibody determination. In this system, chronic atrophic gastritis (CAG) is diagnosed using the pepsinogen test. Patients who are H. pylori negative and pepsinogen negative are classified into group A, are assumed to be H. pylori uninfected, and are at an extremely low risk for gastric cancer. However, gastric cancers are detected in this group. The aim of this study is to clarify the clinicopathological status of group A patients with gastric cancer.
A total of 109 gastric cancer patients classified as group A were enrolled in a multicenter study. Group A patients were divided into two subgroups: group AN (H. pylori uninfected) and group AP (H. pylori infected). They were compared to 183 H. pylori-infected gastric cancer patients who were not in group A.
Of the 109 patients, only 7 were classified as group AN; the other 102 were classified as group AP. The clinicopathological features of group AP included older age, predominantly differentiated type cancer, endoscopically visualized CAG, and pepsinogen (PG) I/II ratio lower than that of group AN. In group AN, the depressed type was dominant, and the PG I/II ratio was higher than in those gastric cancer patients who were infected with H. pylori.
Patients in group AP had CAG, and their gastric cancers were similar to those of H. pylori-eradicated patients. Concerning the recent ABC classification system, advanced decision criteria should be proposed to decrease the false-negative evaluation of gastric cancer risk.
血清风险预测系统结合胃蛋白酶原试验和抗幽门螺杆菌（H. pylori）抗体检测。在该系统中，慢性萎缩性胃炎（CAG）通过胃蛋白酶原试验诊断。H. pylori 阴性和胃蛋白酶原阴性的患者归入 A 组，假定为 H. pylori 未感染，胃癌风险极低。然而，在该组中检测到胃癌。本研究旨在阐明 A 组胃癌患者的临床病理状况。
一项多中心研究共纳入 109 例被归类为 A 组的胃癌患者。A 组患者分为两个亚组：AN 组（H. pylori 未感染）和 AP 组（H. pylori 感染）。并将其与 183 例未归入 A 组的 H. pylori 感染胃癌患者进行比较。
在 109 例患者中，仅有 7 例被归类为 AN 组；其余 102 例被归类为 AP 组。AP 组的临床病理特征包括年龄较大、以分化型为主的癌症、内镜下可见的 CAG 以及胃蛋白酶原（PG）I/II 比值低于 AN 组。在 AN 组中，凹陷型占优势，PG I/II 比值高于 H. pylori 感染的胃癌患者。
AP 组患者存在 CAG，其胃癌与根除 H. pylori 的患者相似。关于最近的 ABC 分类系统，应该提出更严格的决策标准，以减少对胃癌风险评估的假阴性评价。
