Vohlonen Ilkka, Härkönen Matti, Malila Nea, Pukkala Eero, Sipponen Pentti, Koistinen Veli, Hakama Matti
a Department of Public Health, Health Policy , University of Eastern Finland , Kuopio , Finland.
b Department of Clinical Chemistry, Clinical Chemistry , University of Helsinki , Helsinki , Finland.
Acta Oncol. 2017 Jul;56(7):917-922. doi: 10.1080/0284186X.2016.1278304. Epub 2017 Feb 23.
Objective was to quantify biases in screening for gastric cancer when comparing attenders to nonattenders using serum pepsinogen I (SPGI) level as primary test.
In mid 1990s, all men aged 51-65 years from two Finnish cities were invited to SPGI screening. Mortality and premature mortality in attenders were compared to nonattenders. Efficacy of screening was studied by 15 years' follow-up of standardized mortality ratio (SMR) and potential years of life lost (PYLL) due to gastric cancer. Bias due to selective attendance was quantified using corrective coefficients based on total cancer incidence and mortality, and gastric cancer-specific incidence and mortality for total population and nonattenders.
In 1994-1996, men aged 51-65 years (16,872) were invited to SPGI assay and 12,175 men (72%) attended. SPGI was 25 microg/l or less in 610 (5%) men, indicating severe atrophic gastritis (AG). Post-screening gastroscopy was performed to 435 men with low SPGI. Of these, 168 men were referred for treatment due to abnormal focal lesions. Attributable proportions in reductions of SMR and PYLL from gastric cancer due to screening were 59% and 67%. After correcting for selective participation, attributable proportions were reduced to 23% and 39%.
Biomarker screening by low SPGI among middle-aged men followed by upper gastrointestinal endoscopy decreased long-term and premature mortality due to gastric cancer. However, in spite of methodological corrections done, the results do not justify any firm conclusions or recommend general screening programs. Randomized trials are warranted for this purpose.
目的是在将血清胃蛋白酶原I（SPGI）水平作为主要检测指标比较参加筛查者与未参加筛查者时，对胃癌筛查中的偏倚进行量化。
在20世纪90年代中期，邀请了来自芬兰两个城市的所有51 - 65岁男性参加SPGI筛查。将参加者的死亡率和过早死亡率与未参加者进行比较。通过对标准化死亡率（SMR）和因胃癌导致的潜在寿命损失年数（PYLL）进行15年的随访，研究筛查的效果。基于总癌症发病率和死亡率以及总人口和未参加者的胃癌特异性发病率和死亡率，使用校正系数对因选择性参加导致的偏倚进行量化。
在1994 - 1996年，邀请了16872名51 - 65岁男性进行SPGI检测，12175名男性（72%）参加。610名（5%）男性的SPGI为25μg/l或更低，表明患有严重萎缩性胃炎（AG）。对435名SPGI低的男性进行了筛查后胃镜检查。其中，168名男性因局灶性病变异常而被转诊接受治疗。由于筛查导致的胃癌SMR和PYLL降低的归因比例分别为59%和67%。在校正选择性参与后，归因比例分别降至23%和39%。
中年男性中通过低SPGI进行生物标志物筛查并随后进行上消化道内镜检查可降低因胃癌导致的长期和过早死亡率。然而，尽管进行了方法学校正，结果仍不足以得出任何确凿结论或推荐普遍筛查项目。为此有必要进行随机试验。
