Predicting the development of gastric cancer from combining Helicobacter pylori antibodies and serum pepsinogen status: a prospective endoscopic cohort study

Abstract

Background and aims: Helicobacter pylori infection and gastric atrophy are both risk factors for gastric cancer. We aimed to elucidate the natural history of gastric cancer development according to H pylori infection and gastric atrophy status.

Subjects and methods: A total of 9293 participants in a mass health appraisal programme were candidates for inclusion in the present prospective cohort study: 6983 subjects revisited the follow up programme. Subjects were classified into four groups according to serological status at initial endoscopy. Group A (n = 3324) had "normal" pepsinogen and were negative for H pylori antibody; group B (n = 2134) had "normal" pepsinogen and were positive for H pylori antibody; group C (n = 1082) had "atrophic" pepsinogen and were positive for H pylori antibody; and group D (n = 443) had "atrophic" pepsinogen and were negative for H pylori antibody. Incidence of gastric cancer was determined by annual endoscopic examination.

Results: Mean duration of follow up was 4.7 years and the average number of endoscopic examinations was 5.1. The annual incidence of gastric cancer was 0.04% (95% confidence interval (CI) 0.02-0.09), 0.06% (0.03-0.13), 0.35% (0.23-0.57), and 0.60% (0.34-1.05) in groups A, B, C, and D, respectively. Hazard ratios compared with group A were 1.1 (95% CI 0.4-3.4), 6.0 (2.4-14.5), and 8.2 (3.2-21.5) in groups B, C, and D, respectively. Age, sex, and "group" significantly served as independent valuables by multivariate analysis.

Conclusions: The combination of serum pepsinogen and anti-H pylori antibody provides a good predictive marker for the development of gastric cancer.

Figures

Figure 1

Kaplan-Meier analysis of the proportion of gastric cancer development classified by pepsinogen status and Helicobacter pylori antibody (groups A–D, see text for details). During follow up, gastric cancer developed in seven of 3324 group A patients (0.2%), six of 2134 group B patients (0.3%), 18 of 1082 group C patients (1.7%), and 12 of 443 group D patients (2.7%) (p<0.0001 by log rank test).

Figure 2

Incidence rates of gastric cancer stratified by age, sex, and serological status. Subjects older than 60 years in group D showed the highest annual incidence of 1.8% in males and 1.5% in females. The incidence rate in the same age group was much lower in groups A and B, being less than 0.5% per year. Hp-Ab, Helicobacter pylori antibody.