The Serum Pepsinogen Test as a Predictor of Gastric Cancer The Hisayama Study

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 ¼ 17; age-adjusted hazard ratio ¼ 4.56, 95% confidence interval: 2.42, 8.60) and women (n ¼ 6; age-adjusted hazard ratio ¼ 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 ¼ 23; age-adjusted hazard ratio ¼ 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