Value Of Diagnosis Of PG,G-17,CA72-4 And Risk Assessment Of Precancerous Lesion Of Gastric Cancer

Objective To investigate the diagnostic value of serum pepsinogen(PG),gastrin-17(G-17)and carbohydrate antigen 72-4(CA72-4)for precancerous lesions of gastric cancer(PLGC),and to establish PLGC risk assessment model to predict the risk of PLGC and identify individuals with a heightened risk of developing gastric cancer(GC).Methods A total of 397 patients who underwent gastroscopy in the Department of Gastroenterology of the First Hospital of Jiaxing from December 2019 to December 2021 were enrolled as research subjects.According to the results of gastroscopy and pathology,the levels of serum PG I,PG Ⅱ,PG I/PG Ⅱ ratio(PGR),G-17,and CA72-4 were analyzed among non-PLGC and PLGC patients(patients with pathological diagnoses including gastric mucosal atrophy,intestinal metaplasia,intraepithelial neoplasia),different lesion sites(gastric corpus lesion group,gastric antrum lesion group,gastric antrum and corpus lesion group),and different pathological types(atrophic gastritis group and intraepithelial neoplasia group).The diagnostic ability of these serum markers for PLGC was evaluated by the sensitivity,specificity,optimal cut-off value,area under curve(AUC)of the receiver operating characteristic(ROC)curve,positive predictive value(PPV),and negative predictive value(NPV)of each serological marker alone or in combination to diagnose or predict PLGC.A multiple logistic regression model was established to calculate the evaluation value of each serological marker and other risk factors for PLGC.Results 1.The serum CA72-4 level in the PLGC group was higher than that in the non-PLGC group,and the PGR level was lower than that in the non-PLGC group(P<0.05).2.Compared with the atrophic gastritis group,the serum CA72-4 level in the intraepithelial neoplasia group was significantly increased(P<0.05).Compared with the gastric corpus lesion group,the serum G-17 level in the gastric antrum lesion group was decreased(P<0.05).3.Serum PG I,PG Ⅱ,PGR,G-17,and CA72-4 separately have limitations in terms of the specificity or sensitivity for detecting PLGC.However,combined detection can improve the diagnostic efficiency.4.According to ROC curve,the optimal cut-off value for PGR in diagnosing PLGC was determined to be PGR≤6.34.The efficiency of diagnosing PLGC was the higher when PGR≤6.34,G-17>15pmol/L or G-17≤1pmol/L and CA72-4>6.9U/ml were combined.5.In a multivariate logistic regression model,after adjusted for other variables,PGR≤6.34,CA72-4>6.9 U/ml,G-17>15 pmol/L or G-17≤1 pmol/L,age,preference for pickled food,Helicobacter pylori(Hp)infection,and anxiety or depression were independent risk factors for PLGC.This model had higher diagnostic efficiency for PLGC than the combined detection of serum PGR,CA72-4 and G-17.Conclusion 1.The decrease of PGR level,the increase of CA72-4 level,and the excessively high or low level of G-17 indicate a high risk of PLGC.And serum G-17 level has some reference value for indicating precancerous lesions at different sites in the gastric mucosa and serum CA72-4 for suggesting different pathological types.2.Serum PG I,PG II,PGR,CA72-4,and G-17 have limitations in terms of sensitivity or specificity for diagnosing PLGC alone,but combined detection can improve the diagnostic efficiency.PGR(+),CA72-4(+),and G-17(+)in the regression model have good predictive ability for PLGC,providing a reliable clinical basis for identifying high-risk groups for gastric cancer.