Diagnostic Value Of The Combination Of Blood Routine Test,Pepsinogen And Hp Antibody In Gastric Cancer And Precancerous Lesions

Background:Gastric cancer(GC)is one of the most common and deadly cancers in the world.EGC can easily be neglected,and the prognosis of advanced GC is worse.Therefore,early diagnosis and treatment are particularly important to improve the prognosis and the quality of life.Serum pepsinogen(PG)has been proved to be related to different gastric diseases.However,there is no consensus on the cutoff values and the diagnostic efficacy,which limits its wide application.In addition,helicobacter pylori(Hp)infection is one of the most important risk factors for GC,and blood routine test is a common examination for GC patients.Objective:We aimed to find the variation of serum PG and Hp antibody in different gastric diseases,and to explore the diagnostic value of blood routine test,serum PG and Hp antibody in GC and precancerous lesions.Another goal was to establish a predictive model for GC.Methods:The study enrolled patients with stomach complaints at Nanfang Hospital of Southern Medical University from May 1,2017 to June 30,2022.We analyzed the relationship between serum PG and age,sex,Hp antibody,and the difference of age,sex,serum PG and the positive rates of Hp antibody in various stomach diseases.Next,we take non-atrophic gastritis(NAG)as the control group and intraepithelial neoplasia and early gastric cancer(IN+EGC)as the case group.Using the receiver operating characteristic curve(ROC),we calculated the cutoff value and the area under the curve of each variable.Then univariate and multivariate logistic regression analyses were carried out to estimate the predictive factors of IN+EGC.Finally,we divided each group into training set and test set at 8:2.In the training set,the ROC,univariate and multivariate logistic regression analyses were conducted to evaluate the predictive factors of advanced GC.And we established a predictive model for advanced GC and verified the model with the test set.Results:828 patients met the inclusion and exclusion criteria,and 755 patients were obtained after removing outliers,including 179 patients in NAG group,501 patients in chronic atrophic gastritis(CAG)group,and 75 patients in GC group.(1)The PGⅠ level in men was significantly higher than that in women.The PGⅡlevel in male,aged,and Hp antibody positive patients was respectively higher than that in female,younger,and Hp antibody negative patients,while compared with that of the younger,and the Hp antibody negative group,the ratio of PGⅠ/Ⅱ(PGR)of the aged,and the Hp antibody positive group was lower.The positive rate of Hp antibody in NAG group was lower,and the age and the level of PGⅡ raised gradually with the development of NAG-CAG-GC,while PGR declined.(2)Age,PGⅡ,platelet count(PLT)and Hp antibody were independent predictors of IN+EGC,but the diagnostic efficacy of each variable was low.However,with the number of positive indicators increasing from 0 to 4,the proportion of IN+EGC was 22.4%,43.4%,62.8%,65.3%and 90%,respectively.(3)In the training set,age,PGⅡ,PGR,neutrophil count(NEU),hemoglobin(HGB),PLT,platelet-to-lymphocyte ratio(PLR)were significantly different between the advanced GC group and the control group,but the diagnostic value of each variable alone was not high.Multivariate analysis showed that PGⅡ,NEU,HGB and PLR were predictors of advanced GC.Combined with four variables,the prediction model was established as Score=PGⅡ+2NEU+HGB+2PLR.And the score of 0-2 was assigned to low-risk group for advanced GC,while the score of 3-6 was assigned to high-risk group.The sensitivity and specificity of the model was 85.7%and 70.7%,and 8 of 9 cases of advanced GC in the test set could be diagnosed using the model.Conclusion:Age,PGⅡ,PLT and Hp antibody were predictors of IN+EGC.According to the cutoff value,more than two of the four indicators with positive events had a higher risk of developing IN+EGC,and further gastroscopic inspection was suggested.Score=PGⅡ+2NEU+HGB+2PLR could be used as the prediction model of GC in the advanced stage and in the high-risk group,it was recommended to improve gastroscopic inspection as soon as possible.