Follow-up study on a high risk population of gastric cancer in north China by serum pepsinogen assay

OBJECTIVE: To explore the features and clinical significance of serum pepsinogen (PG) assay in a follow-up study on a high-risk gastric cancer (GC) population. METHODS: A total of 444 participants from a high-risk area of GC in north China were enrolled in this follow-up study from April 1997 to December 1999. Serum PC was measured by enzyme-linked immunosorbent assay (ELISA), and the percentage changes in PC were calculated with, PC (follow-up)/PG (first) (test)' thrice from the beginning to the end of these 30 months. Stomach diseases were diagnosed by a gastroscopy with biopsy examination. Helicobacter pylori (H. pylori) status was assessed by histopathological examination and serum H. pylori-immunoglobulin (Ig)G antibody assay with ELISA. RESULTS: In all groups except for the 51-60-year olds no significant differences of percentage changes in PGII and the PGI/II ratio were observed during 30-month follow-up period. In the superficial gastritis (SG) group the percentage change in PGI of group A (after 6 months' follow up) was significantly lower than that of group B (after 12 months' follow up) (0.69 vs 0.97, P = 0.002) in SG -> SG; while in SG -> normal (NOR), it was significantly higher than that in SG -> atrophic gastritis (AG) (0.94 vs 0.79, P = 0.022). In the AG group the percentage change in the PGI/II ratio of group A was significantly higher than that of group C (after 30 months' follow up) (1.13 vs 0.75, P = 0.042) in AG -> AG; and the percentage changes in PGI and PGII in AG -> NOR were significantly lower than those in AG -> SG (0.43 vs 0.87, P = 0.000; 0.60 vs 1.11, P = 0.010, respectively). In the H. pylori(-) (Hp(-)) group, the percentage change in PC of Hp(-)-> Hp(+) was significantly higher than that of Hp(-)-> Hp(-) (0.94 vs 0.81, P = 0.026). Percentage changes in PGI and PGII of Hp(+)-> Hp(-) were significantly lower than those of Hp(+)-> Hp(+) (0.74 vs 0.93, P=0.000; 0.86 vs 1.15, P = 0.000, respectively), while the percentage change in the PGI/II ratio was higher than that the group of Hp(+)-> Hp(-) (0.9 0 vs 0.70, P = 0.022). CONCLUSION: The serum PC levels were influenced by the physiopathologic status of gastric mucosa and H. pylori infection, but they altered during the period of follow up. Serum PC assay might be a feasible and appropriate procedure to use in following up on a high-risk GC population.