GASTRIC CANCER

Predicting the development of gastric cancer from combining Helicobacter pylori antibodies and serum pepsinogen status: a prospective endoscopic cohort study

H Watabe¹, T Mitsushima², Y Yamaji¹, M Okamoto³, R Wada⁴, T Kokubo⁵, H Doi⁶, H Yoshida³, T Kawabe³ and M Omata³

¹ Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan, and Makuhari Clinic, Chiba, Japan
² Makuhari Clinic, Chiba, Japan, and Department of Gastroenterology, Kameda General Hospital, Chiba, Japan
³ Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
⁴ Department of Gastroenterology, Kameda General Hospital, Chiba, Japan
⁵ Department of Pathology, Kameda General Hospital, Chiba, Japan
⁶ Makuhari Clinic, Chiba, Japan

Correspondence to:
Correspondence to:
Dr H Watabe
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; hwatabe-gi{at}umin.ac.jp

Background and aim: Helicobacter pylori infection and gastric atrophy are both risk factors for gastric cancer. We aimed to elucidate the natural history of gastric cancer development according to H pylori infection and gastric atrophy status.

Subjects and methods: A total of 9293 participants in a mass health appraisal programme were candidates for inclusion in the present prospective cohort study: 6983 subjects revisited the follow up programme. Subjects were classified into four groups according to serological status at initial endoscopy. Group A (n = 3324) had "normal" pepsinogen and were negative for H pylori antibody; group B (n = 2134) had "normal" pepsinogen and were positive for H pylori antibody; group C (n = 1082) had "atrophic" pepsinogen and were positive for H pylori antibody; and group D (n = 443) had "atrophic" pepsinogen and were negative for H pylori antibody. Incidence of gastric cancer was determined by annual endoscopic examination.

Results: Mean duration of follow up was 4.7 years and the average number of endoscopic examinations was 5.1. The annual incidence of gastric cancer was 0.04% (95% confidence interval (CI) 0.02–0.09), 0.06% (0.03–0.13), 0.35% (0.23–0.57), and 0.60% (0.34–1.05) in groups A, B, C, and D, respectively. Hazard ratios compared with group A were 1.1 (95% CI 0.4–3.4), 6.0 (2.4–14.5), and 8.2 (3.2–21.5) in groups B, C, and D, respectively. Age, sex, and "group" significantly served as independent valuables by multivariate analysis.

Conclusions: The combination of serum pepsinogen and anti-H pylori antibody provides a good predictive marker for the development of gastric cancer.

Keywords: gastric cancer; Helicobacter pylori; pepsinogen; endoscopy; screening

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