Clinical Value of Pepsinogen in the Screening, Prevention, and Diagnosis of Gastric Cancer

Detection of chromosomal instability using ultrasensitive chromosomal aneuploidy detection in the diagnosis of precancerous lesions of gastric cancer

Background

The diagnosis of Precancerous Lesions of Gastric Cancer (PLGC) is challenging in clinical practice. We conducted a clinical study by analyzing the information of relevant chromosome copy number variations (CNV) in the TCGA database followed by the UCAD technique to evaluate the value of Chromosomal Instability (CIN) assay in the diagnosis of PLGC.

Methods

Based on the screening of gastric cancer related data in TCGA database, CNV analysis was performed to explore the information of chromosome CNV related to gastric cancer. Based on the gastroscopic pathology results, 12 specimens of patients with severe atrophy were screened to analyze the paraffin specimens of gastric mucosa by UCAD technology, and to explore the influence of related factors on them.

Results

The results of CNV in TCGA database suggested that chromosome 7, 8, and 17 amplification was obvious in patients with gastric cancer. UCAD results confirmed that in 12 patients with pathologic diagnosis of severe atrophy, five of them had positive results of CIN, with a positive detection rate of 41.7%, which was mainly manifested in chromosome seven and chromosome eight segments amplification. We also found that intestinalization and HP infection were less associated with CIN. And the sensitivity of CIN measurement results was significantly better than that of tumor indicators.

Conclusion

The findings suggest that the diagnosis of PLGC can be aided by UCAD detection of CIN, of which Chr7 and 8 may be closely related to PLGC.

Prediction of canceration of gastric ulcer with serum pepsinogen Ⅰ/Ⅱ ratio and gastrin-17

BACKGROUND

Screening sensitivity markers for canceration of gastric ulcer is of great significance for the prevention and treatment of gastric cancer. Previous studies have suggested that pepsinogen and gastrin-17 (G-17) may have appreciated value in the prediction of early gastric cancer, but there is still no definitive consensus on this.

AIM

To assess the clinical value of serum pepsinogen I (PGⅠ)/pepsinogen Ⅱ (PGⅡ) ratio combined with G-17 in predicting canceration of gastric ulcer to provide sensitive biochemical markers for early diagnosis of gastric cancer.

METHODS

A retrospective analysis was conducted on 215 patients with gastric ulcer at our hospital from July 2020 to April 2023. According to the histopathological diagnosis by gastroscopy, the patients were divided into either a simple ulcer group (184 cases) or a gastric cancer group (31 cases). Serum PGⅠ, PGⅡ, G-17, and tumor markers [including carbohydrate antigen (CA)724, CA199, carcinoembryonic antigen (CEA), and ferritin] were detected on admission. The delta over baseline (DOB) value of Helicobacter pylori (H. pylori) infection was measured by the ¹³C breath test.

RESULTS

There were no differences in gender, age, DOB value, or disease course between the two groups (P > 0.05). Compared with the simple ulcer group, serum levels of PGⅡ, G-17, CA724, CA199, and CEA in the gastric cancer group were increased, while PGⅠ, ferritin, and PGⅠ/PGⅡ ratio were decreased (P < 0.05). Spearman test showed that PGⅠ/PGⅡ ratio was negatively correlated with G-17, CA724, CA199, and CEA, and positively correlated with ferritin (P < 0.05). G-17 was positively correlated with CA724, CA199, and CEA, and negatively correlated with ferritin (P < 0.05). Receiver operating curve (ROC) analysis showed that the area under the ROC curve (AUC) of PGⅠ/PGⅡ ratio and G-17 for diagnosing canceration of gastric ulcer was 0.804 and 0.742, respectively. The AUC of PGⅠ/PGⅡ ratio combined with G-17 was 0.899, significantly higher than that of either indicator alone (P < 0.05).

CONCLUSION

The decrease of serum PGⅠ/PGⅡ ratio and increase of G-17 are closely related to the canceration of gastric ulcer. The combination of PGⅠ/PGⅡ ratio and G-17 has good predictive performance for canceration of gastric ulcer. PGⅠ/PGⅡ ratio and G-17 can serve as sensitive biomarkers for the early diagnosis of gastric cancer.

Risk Factors Analysis and Prediction Model Establishment of Intestinal Metaplasia or Dysplasia in Patients With Chronic Atrophic Gastritis: A Multi-Center Retrospective Study

Objective

To investigate the risk factors and construct a prediction model of chronic atrophic gastritis (CAG) patients with intestinal metaplasia or dysplasia.

Method

The clinical data of 450 patients with CAG who were diagnosed and treated in the Department of Gastroenterology of the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine from June 2016 to February 2022 were collected. Single and multiple factors logistic regression analysis were used to explore the risk factors of intestinal metaplasia or dysplasia in patients of training cohort. Then, we constructed a model to predict the onset of intestinal metaplasia or dysplasia based on the data of training cohort, following which we tested the model in an external validation cohort of 193 patients from a local university teaching hospital. The ROC curve, calibration curve, and decision curve analysis were used to evaluate the accuracy of the prediction model.

Result

Helicobacter pylori (H. pylori, HP) infection, pepsinogen I, gastrin-17, and the number of lesions were found to be independent rick factors of the model. The liner prediction model showed excellent predictive value in both training cohort and validation cohort.

Conclusion

HP infection, pepsinogen I, gastrin-17, and the number of lesions are independent risk factors for intestinal metaplasia or dysplasia in patients with CAG. The prediction model constructed based on these factors has a high accuracy and excellent calibration, which can provide a great basis for condition assessment and individualized treatment of the patients.