Hamashima Chisato, Sasazuki Shizuka, Inoue Manami, Tsugane Shoichiro
Division of Cancer Screening Assessment and Management, Center for Social Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan.
Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan.
BMC Cancer. 2017 Mar 9;17(1):183. doi: 10.1186/s12885-017-3173-0.
Chronic Helicobacter pylori infection plays a central role in the development of gastric cancer as shown by biological and epidemiological studies. The H. pylori antibody and serum pepsinogen (PG) tests have been anticipated to predict gastric cancer development.
We determined the predictive sensitivity and specificity of gastric cancer development using these tests. Receiver operating characteristic analysis was performed, and areas under the curve were estimated. The predictive sensitivity and specificity of gastric cancer development were compared among single tests and combined methods using serum pepsinogen and H. pylori antibody tests.
From a large-scale population-based cohort of over 100,000 subjects followed between 1990 and 2004, 497 gastric cancer subjects and 497 matched healthy controls were chosen. The predictive sensitivity and specificity were low in all single tests and combination methods. The highest predictive sensitivity and specificity were obtained for the serum PG I/II ratio. The optimal PG I/II cut-off values were 2.5 and 3.0. At a PG I/II cut-off value of 3.0, the sensitivity was 86.9% and the specificity was 39.8%. Even if three biomarkers were combined, the sensitivity was 97.2% and the specificity was 21.1% when the cut-off values were 3.0 for PG I/II, 70 ng/mL for PG I, and 10.0 U/mL for H. pylori antibody.
The predictive accuracy of gastric cancer development was low with the serum pepsinogen and H. pylori antibody tests even if these tests were combined. To adopt these biomarkers for gastric cancer screening, a high specificity is required. When these tests are adopted for gastric cancer screening, they should be carefully interpreted with a clear understanding of their limitations.
生物学和流行病学研究表明，幽门螺杆菌慢性感染在胃癌发生过程中起核心作用。幽门螺杆菌抗体和血清胃蛋白酶原（PG）检测被期望用于预测胃癌的发生。
我们使用这些检测方法确定了胃癌发生的预测敏感性和特异性。进行了受试者工作特征分析，并估计了曲线下面积。比较了使用血清胃蛋白酶原和幽门螺杆菌抗体检测的单项检测及联合方法对胃癌发生的预测敏感性和特异性。
从1990年至2004年随访的超过10万名受试者的大规模人群队列中，选取了497例胃癌患者和497例匹配的健康对照。所有单项检测和联合方法的预测敏感性和特异性均较低。血清PG I/II比值的预测敏感性和特异性最高。最佳的PG I/II临界值分别为2.5和3.0。在PG I/II临界值为3.0时，敏感性为86.9%，特异性为39.8%。即使将三种生物标志物联合使用，当PG I/II临界值为3.0、PG I为70 ng/mL、幽门螺杆菌抗体为10.0 U/mL时，敏感性为97.2%，特异性为21.1%。
即使联合使用血清胃蛋白酶原和幽门螺杆菌抗体检测，对胃癌发生的预测准确性也较低。要将这些生物标志物用于胃癌筛查，需要高特异性。当采用这些检测方法进行胃癌筛查时，应清楚了解其局限性并谨慎解读结果。
