A Serological Biopsy Using Five Stomach‐Specific Circulating Biomarkers for Gastric Cancer Risk Assessment: A Multi‐Phase Study. (May 2017) - Tu, Huakang
Abstract : Objectives: We aimed to assess a serological biopsy using five stomach‐specific circulating biomarkers—pepsinogen I (PGI), PGII, PGI/II ratio, anti ‐ Helicobacter pylori (H. pylori) antibody, and gastrin‐17 (G‐17)—for identifying high‐risk individuals and predicting risk of developing gastric cancer (GC). Methods: Among 12, 112 participants with prospective follow‐up from an ongoing population‐based screening program using both serology and gastroscopy in China, we conducted a multi‐phase study involving a cross‐sectional analysis, a follow‐up analysis, and an integrative risk prediction modeling analysis. Results: In the cross‐sectional analysis, the five biomarkers (especially PGII, the PGI/II ratio, and H. pylori sero‐positivity) were associated with the presence of precancerous gastric lesions or GC at enrollment. In the follow‐up analysis, low PGI levels and PGI/II ratios were associated with higher risk of developing GC, and both low (<0.5 pmol/l) and high (>4.7 pmol/l) G‐17 levels were associated with higher risk of developing GC, suggesting a J‐shaped association. In the risk prediction modeling analysis, the five biomarkers combined yielded a C statistic of 0.803 (95% confidence interval (CI)=0.789–0.816) and improved prediction beyond traditional risk factors (C statistic from 0.580 to 0.811, P <0.001) for identifying precancerous lesions at enrollment, and higher serological biopsy scores based on the five biomarkers at enrollment were associated with higher risk of developing GC during follow‐up ( P for trend <0.001). Conclusions: A serological biopsy composed of the five stomach‐specific circulating biomarkers could be used to identify high‐risk individuals for further diagnostic gastroscopy, and to stratify individuals' risk of developing GC and thus to guide targeted screening and precision prevention.