评估胃癌高发区胃癌及癌前疾病的血清标志物。
Evaluation of serum markers for gastric cancer and its precursor diseases among high incidence and mortality rate of gastric cancer area.
机构信息
Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
Department of Gastroenterology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
出版信息
Gastric Cancer. 2019 Jan;22(1):104-112. doi: 10.1007/s10120-018-0844-8. Epub 2018 Jun 22.
BACKGROUND
Mongolia has the highest mortality rate of gastric cancer. The early detection of cancer and down-staging screening for high risk patients are essential. Therefore, we aimed to validate serum markers for stratifying patients for further management.
METHODS
Endoscopy and histological examination were performed to determine high risk and gastric cancer patients. Rapid urease test, culture and histological tests were performed to diagnose Helicobacter pylori infection. Serum pepsinogen (PG) I and II and anti-H. pylori IgG were measured by ELISA. Receiver Operating Characteristic analysis was used to extract the best cut-off point.
RESULTS
Totally 752 non-cancer and 50 consecutive gastric cancer patients were involved. The corpus chronic gastritis (72%: 36/50 vs. 56.4%: 427/752), corpus atrophy (42.0%: 21/50 vs. 18.2%: 137/752) and intestinal metaplasia (IM) (64.0%: 32/50 vs. 21.5%: 162/752) were significantly higher in gastric cancer than non-cancer patients, respectively. Therefore, corpus chronic gastritis, corpus atrophy and IM were considered as high risk disease. The best serum marker to predict the high risk status was PGI/II < 3.1 (sensitivity 67.2%, specificity 61%) and PGI/II further reduced to < 2.2 (sensitivity 66%, specificity 65.1%) together with PGI < 28 ng/mL (sensitivity 70%, specificity 70%) were the best prediction for gastric cancer. The best cut-off point to diagnose H. pylori infection was anti-H. pylori IgG > 8 U/mL. Multivariate analysis showed that anti-H. pylori IgG > 8 U/mL and PGI/II < 3.1 increased risk for high risk status and PGI/II < 3.1 remained to increase risk for gastric cancer.
CONCLUSION
The serum diagnosis using PGI/II < 3.1 cut-off value is valuable marker to predict high risk patients for population based massive screening.
背景
蒙古的胃癌死亡率居世界之首。癌症的早期发现和高危患者的降期筛查至关重要。因此，我们旨在验证血清标志物，以便对患者进行分层管理。
方法
通过内镜和组织学检查确定高危和胃癌患者。通过快速尿素酶试验、培养和组织学检查诊断幽门螺杆菌感染。通过 ELISA 法测定血清胃蛋白酶原（PG）I 和 II 以及抗幽门螺杆菌 IgG。采用受试者工作特征分析提取最佳截断值。
结果
共纳入 752 例非癌患者和 50 例连续胃癌患者。胃癌患者的胃体慢性炎症（72%：36/50 比 56.4%：427/752）、胃体萎缩（42.0%：21/50 比 18.2%：137/752）和肠化生（64.0%：32/50 比 21.5%：162/752）明显高于非癌患者。因此，胃体慢性炎症、胃体萎缩和肠化生被认为是高危疾病。预测高危状态的最佳血清标志物是 PGI/II<3.1（敏感性 67.2%，特异性 61%），PGI/II 进一步降低至<2.2（敏感性 66%，特异性 65.1%），同时 PGI<28ng/mL（敏感性 70%，特异性 70%）是预测胃癌的最佳指标。诊断幽门螺杆菌感染的最佳截断值是抗幽门螺杆菌 IgG>8U/mL。多因素分析显示，抗幽门螺杆菌 IgG>8U/mL 和 PGI/II<3.1 增加了高危状态的风险，而 PGI/II<3.1 仍然增加了胃癌的风险。
结论
使用 PGI/II<3.1 截断值的血清诊断对基于人群的大规模筛查具有预测高危患者的价值。
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