Serum pepsinogen level as a predictor of gastric cancer

Abstract

Introduction: Mongolia has the highest mortality rate of gastric cancer (GC). Early detection and treatment can reduce the mortality of GC. Therefore, it is important to establish an efÏcient and better cost effective screening method for early detection of gastric cancer in regular mass survey. Purpose: The purpose of this study is to evaluate serum pepsinogen I(PGI), pepsinogen II(PGII) and pepsinogen I/II ratio (PGI/II) in patients with gastric cancer in our country. Materials and Methods: We investigated subjects with histologically proven adenocarcinoma who underwent GC-related operative treatment either at National Cancer Center in 2019-2020. In addition, relatively healthy people were age and gender adjustably selected from the department of endoscopy. In the two categories of the study, the PGI, PGII, PGI/ II ratio screening test were performed by ELISA (enzyme linked immunosorbent assay) using the GastroPanel Elisa Kit from BIOHIT HealthCare, Finland and BIOBASE-EL10A reader album of Biobase Biodustry of China guidelines. Result: A total of 82 subjects (43 males, 39 females) were eligible for this study, and their mean age was 61.21 (±13.75) years. The mean serum PGI and PGII levels and PG I/II ratio were 78.76(±60.56) ng/ml, 17.45(±13.14) ng/ml ,and 5.28(±4.18), respectively. The characteristics of the subjects without neoplasms and those with gastric neoplasms were compared; among the serological markers evaluated, the PGII level was not significantly different between the 2 groups (13.29± 5.98 vs 14.94±10.44 ng/ml, p=0.434). However, significant differences were found in the serum PGI level (68.11±35.39 vs 43.35±36.67 ng/ml, p<.009) and PGI/II ratio (5.49±2.83 vs 3.4 ±2.56, p<.004). PGI and PGII levels were assessed at 94.23 ± 62.55 ng/ml, 21.47 ± 16.03 ng/ml at 60 under of age and 64.74 ± 55.77 ng/ml, 13.79 ± 8.49 ng/ ml at 60 over of age. This is age related levels of PGI (p = 0.027) and PGII (p=0.007) decrease with statistically significant differences. In the group assessment of the participants serum PGI/II ratio, the significant difference between the serum PGI (p=0.000) and PGI/II ratio (p=0.000) decreased. When comparing PGI, PGII, and PGI/II levels in the study groups by multivariate regression analysis, the reduction in PGI ≤30ng/ml and PGI/II ≤4 was statistically significant in gastric cancer (PGI: OR = 6.44, 95% CI 2.03 -20.45, p=0.002; PGI/II: OR = 4.05, 95% CI 1.41-11.64, p=0.01). The cut-off value of PGI/II was 4 and the sensitivity and specificity were rated at 61% and 72.0% (PPV 67% and NPV 65%) by the Youden index. PGI biomarker cut off 30ng/ml, sensitivity 57%, specificity 82% (PPV 72%, NPV 70%), PGII biomarker cut off 14ng/ml, sensitivity 50%, specificity 58% (PPV 42%) , NPV (65%). Conclusion: Serum PGI and PGI/II ratios are significantly reduced in gastric cancer. Serum PG levels decrease with statistical significance with age. In gastric cancer, PGI levels are more important than serum PGII levels. The cut-off value for the diagnosis of gastric cancer is 57% sensitivity, 82% specificity at PGI ≤30ng/ml and 61% sensitivity, and 72.0% specificity at PGI/II ≤4. ‑