Kishino Takaaki, Oyama Tsuneo, Tomori Akihisa, Takahashi Akiko, Shinohara Tomoaki
Department of Endoscopy, Saku Central Hospital Advanced Care Center, Japan.
Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Japan.
Intern Med. 2020 Jun 15;59(12):1473-1480. doi: 10.2169/internalmedicine.3521-19. Epub 2020 Mar 19.
Objective The aim of the present study was to evaluate the effectiveness and limitations of a serum screening system for predicting the risk of gastric cancer. Methods Serum pepsinogen I (PG I)/pepsinogen II (PG II) and Helicobacter pylori (HP) antibody levels were measured. Subjects were classified into four groupsaccording to their serological status (the ABC classification system). The grade of atrophic gastritis was assessed endoscopically. We evaluated gastric cancer detection rates according to the ABC classification system and the endoscopic grade of atrophy. Patients Individuals who underwent esophagogastroduodenoscopy (EGD) in a health check were prospectively enrolled in the present study. Results According to the ABC classification system, the gastric cancer detection rates in groups A, B, C, and D were 0.07% (4/6,105), 0.5% (8/1,739), 0.8% (16/2,010), and 1.1% (3/281), respectively. The gastric cancer detection rates in subjects with no atrophy, closed type (C-type) atrophy, and open type (O-type) atrophy were 0% (0/4,567), 0.2% (4/2,581), and 0.9% (27/2,987), respectively. In group A (HP(-)/PG(-)), the proportions of subjects with no atrophy, C-type atrophy, and O-type atrophy were 71.2%, 22.8%, and 6.0%, respectively. In group A, the gastric cancer detection rates in subjects with no atrophy, C-type atrophy, and O-type atrophy were 0%, 0.07%, and 0.8%, respectively. Conclusion The ABC classification system is useful for predicting the risk of gastric cancer. However, this system was limited in group A, which included individuals with a high risk of developing gastric cancer. An endoscopic diagnosis of atrophy may be more effective than the ABC classification system for predicting the risk of gastric cancer.
目的 本研究旨在评估一种血清筛查系统预测胃癌风险的有效性和局限性。方法 检测血清胃蛋白酶原I（PG I）/胃蛋白酶原II（PG II）和幽门螺杆菌（HP）抗体水平。根据血清学状态（ABC分类系统）将受试者分为四组。通过内镜检查评估萎缩性胃炎的分级。我们根据ABC分类系统和内镜下萎缩分级评估胃癌检出率。患者 在健康检查中接受食管胃十二指肠镜检查（EGD）的个体被前瞻性纳入本研究。结果 根据ABC分类系统，A、B、C和D组的胃癌检出率分别为0.07%（4/6,105）、0.5%（8/1,739）、0.8%（16/2,010）和1.1%（3/281）。无萎缩、闭合型（C型）萎缩和开放型（O型）萎缩受试者的胃癌检出率分别为0%（0/4,567）、0.2%（4/2,581）和0.9%（27/2,987）。在A组（HP（-）/PG（-））中，无萎缩、C型萎缩和O型萎缩受试者的比例分别为71.2%、22.8%和6.0%。在A组中，无萎缩、C型萎缩和O型萎缩受试者的胃癌检出率分别为0%、0.07%和0.8%。结论 ABC分类系统有助于预测胃癌风险。然而，该系统在A组（包括胃癌发生风险高的个体）中存在局限性。对于预测胃癌风险，内镜下萎缩诊断可能比ABC分类系统更有效。
