Serum Pepsinogen Levels, Helicobacter pylori CagA Status, and Cytokine Gene Polymorphisms Associated with Gastric Premalignant Lesions in Costa Rica

S. A. Con, R. Con-Wong, G. R. Con-Chin, V. G. Con-Chin, H. Takeuchi, A. L. Valerin, G. Echandi, F. Mena, F. Brenes, N. Yasuda, K. Araki, T. Sugiura
2007 Cancer Epidemiology, Biomarkers and Prevention  
The detection of gastric premalignant lesions, atrophic gastritis, corpus atrophic gastritis, and intestinal metaplasia, using several potential markers was examined in Costa Rica. Depending on the lesion investigated, from a total of 223 dyspeptic patients, 58 (26.0%), 31 (13.9%), or 23 (10.3%) were histologically diagnosed with atrophic gastritis, corpus atrophic gastritis, or intestinal metaplasia, respectively. Sera were used for the measurement of pepsinogen (PG) and Helicobacter pylori
more » ... A antibody (CagA-ab) levels by ELISA, and human genomic DNAs were used for the genotyping of interleukin (IL)-1B (À511 and +3954), IL-10 (À1082 and À592), and IL-1RN intron 2 by PCR and RFLP. Multivariate analysis was done adjusting for sex, age, and H. pylori seropositivity. Low PG levels (L-PG; PG I V70 Mg/L + PG I/II V3), very low PG levels (VL-PG; PG I V30 Mg/L + PG I/II V2), and CagA-ab were individually associated with all premalignant lesions whereas IL-1B +3954T-carrier and IL-1RN homozygous 2 allele were associated with intestinal metaplasia. VL-PG, for corpus atrophic gastritis detection, was the single marker with the highest combination of test characteristics, sensitivity (77.4%), specificity (80.7%), positive predictive value (39.3%), negative predictive value (95.7%), and seropositivity rate (27.4%), expected to improve after periodic measurements. Combined examinations of VL-PG and CagA-ab improved the specificity (92.7%) and positive predictive value (62.2%), with similar sensitivity (74.2%) and negative predictive value (95.7%). In conclusion, corpus atrophic gastritis detection with periodic measurements of serum PG, alone or in combination with CagA-ab status, to identify high gastric cancer risk, seems to be the method best suited for mass screening in Costa Rica. (Cancer Epidemiol Biomarkers Prev
doi:10.1158/1055-9965.epi-07-0215 pmid:18086767 fatcat:wj4itr7le5athp7o4l2734pvlq