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American Journal of Epidemiology Advance Access originally published online on January 27, 2006
American Journal of Epidemiology 2006 163(7):629-637; doi:10.1093/aje/kwj088
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Original Contribution

The Serum Pepsinogen Test as a Predictor of Gastric Cancer

The Hisayama Study

Yoshinori Oishi1, Yutaka Kiyohara1, Michiaki Kubo1, Keiichi Tanaka1, Yumihiro Tanizaki1, Toshiharu Ninomiya1, Yasufumi Doi1, Kentaro Shikata1, Koji Yonemoto1, Tomoko Shirota2, Takayuki Matsumoto1 and Mitsuo Iida1

1 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
2 Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan

Reprint requests to Dr. Yoshinori Oishi, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Fukuoka 812-8525, Japan (e-mail: oishi{at}intmed2.med.kyushu-u.ac.jp).

The authors examined whether a serum pepsinogen test (SPT) based on the combination of the serum pepsinogen I level and pepsinogen I/II ratio is a good predictor of gastric cancer occurrence in a general Japanese population. A total of 2,446 subjects aged ≥40 years were classified into negative, positive, and strong-positive SPT groups and were followed prospectively for 14 years (1988–2002). Compared with that for the negative SPT group (26 men, 10 women), gastric cancer incidence increased significantly for both men (n = 17; age-adjusted hazard ratio = 4.56, 95% confidence interval: 2.42, 8.60) and women (n = 6; age-adjusted hazard ratio = 5.84, 95% confidence interval: 2.00, 17.11) in the strong-positive SPT group. It was also significantly higher in the positive SPT group for men (n = 23; age-adjusted hazard ratio = 3.91, 95% confidence interval: 2.23, 6.86). These associations did not attenuate even after adjustment for other comprehensive risk factors. Stratified analysis revealed significant associations between the SPT and development of intestinal-type gastric cancer as well as of cancer in both Helicobacter pylori–negative and –positive subjects. These findings suggest that the SPT can serve as a predictor of intestinal-type gastric cancer, irrespective of H. pylori infection.

cohort studies; gastritis, atrophic; Helicobacter pylori; pepsinogens; stomach neoplasms


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