| ObjectiveTo explore the feasibility for screening gastric cancers and high risk population by serum pepsinogens (PGs, PGI&PGII) and gastrin-17(G-17)-based tests among the crowds with interference of acid inhibitory drugs. And, to analyze the value for gastric cancer screening with PGs and G-17-based tests combined with serum GPDA, CEA and CA72-4detections.Methods1.176cases were involved in this research, of whom88cases had gastric cancer,30cases had precancerous lesion (12cases with Intestinal metaplasia and18cases with dysplasia), and58cases were selected as controls. The serum PGs and G-17levels of all subjects were measured by chemiluminescence microparticle immunoassay (CMIA) and Enzyme linked immunosorbent assay (ELISA), respectively. Values of PGR(ratio between PG Ⅰ and PGⅡ) and GPR(ratio between G-17and PGI) were calculated.2. Serum levels of GPDA were measured by continuous monitoring assay in automatic biochemical analyzer. Serum CA72-4and CEA were measured by electrochemiluminescence immunoassay (ECLIA).3. Explore the clinical significance of combined assay of serum PGs, G-17levels and the concentration of GPDA, CEA and CA72-4for gastric cancer screening.Results 1. Among the non-users, gastric cancer patients had significantly lower PG Ⅰ and higher PG Ⅱ than those in control group (P<0.05) while neither PG Ⅱ nor PGⅡ level was significantly different from precancerous group; gastric cancer patients also had significantly lower PGR (P<0.01) with higher G-17and GPR (P<0.05)as compared with the controls or patients with precancerous lesions.2. The median levels of PG Ⅰ, PGⅡ and G-17were significantly (P<0.05) increased among the subjects who reported use of PPIs while not H2RAs during the previous one week than among non-users, adjusted by gastric mucosa histopathology. The values of PGR and GPR were similar between PPI users and non-users, or those using H2RAs. Gastric cancer patients had significantly lower PGR and higher GPR as compared with the patients in other two groups (.P<0.05)3. ROC curve analysis showed that AUC for PGR and GPR for gastric cancer detection were0.836and0.720, respectively. The best cutoff values of PGR and GPR for detecting gastric cancer calculated by ROC curve were5.9and90, respectively,with moderate diagnostic sensitivity (76.1%and60.2%, respectively) and specificity (70.5%). Detecting rates of patients with dysplasia lesions were55.6%(10/18),22.2%(4/18) with the same cutoff values of PGR and GPR. The detection sensitivity and specificity with the combination of PGR and GPR with "or"(defined as positive when any marker was positive) were93.2%and51.1%, respectively; while with the combination of PGR and GPR with "and"(defined as positive when both markers were positive), sensitivity and specificity were43.2%and88.6%, respectively.4. The sensitivity of GPDA, CEA and CA72-4for gastric cancer detection were36.4%,18.2%,22.7%, respectively. The sensitivity of combined detection of the three tumor markers(TM) increased to56.8%with specificity of87.5%. 5. The sensitivity and specificity of the second screening with the combined detection of GPDA, CEA, CA72-4were45.5%,95.5%, respec-tively, followed abnormal PGR or GPR (PGR≥5.9, GPR≤90) as first screening markers. The specificity was significantly increased compared with that of second screening, with markedly reduction in sensitivity(P <0.001). Taken PGR≤3.7, GPR≥230also as second screening markers, the sensitivity and specificity for gastric cancer screening were81.8%,84.1%, respectively. In addition,77.8%early gastric cancer patients could be detected.Conclusion1. Gastric cancer patients have lower serum PG I and PGR levels accompanied by higher PG Ⅱ, G-17and GPR than those controls. That indicates serum levels of PGs, G-17and the ratios PGR, GPR are all correlated with gastric cancer.2. PPIs can increase the fasting levels of serum pepsinogens and G-17independent of gastric mucosa change while values of PGR and GPR can keep stable with the assumption of acid-inhibitory drugs, PPIs or H2RAs. In addition, the efficency of PGR and GPR in gastric cancer screening are both high. The results indicate both PGR and GPR can be used for gastric cancer screening in population with interference of acid-inhibitory drugs.3. The sensitivity and specificity are both high combined PGR, GPR with serum assay of GPDA, CEA, CA72-4for gastric cancer screening, which are81.8%and84.1%, respectively. Meanwhile, the detection rate of early gastric cancer is also high through the procedure. Those indicate the screening procedure has potential clinical application values. |
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