Background: Gastric carcinoma is relatively uncommon in Japan among persons younger than 40 years of age, but its prognosis is not favorable and it affects young adults in their most productive years. This study was performed to evaluate the validity of serum pepsinogen as a new marker for gastric carcinoma among Japanese younger than 40 years of age.
Methods: Data and sera were collected from the patients (108 patients younger than 40 years of age with gastric carcinoma from nine hospitals in the Kanto-Shin'etsu area in Japan) and from the control subjects (108 hospital control subjects and 108 screening control subjects) whose sex and age (within 4 years) were matched. Pepsinogen I and pepsinogen II values were measured and compared between patients and control subjects by paired t test. Sensitivities and specificities when criteria were defined by pepsinogen I, pepsinogen II, and pepsinogen I/II ratio were calculated.
Results: The pepsinogen I and pepsinogen II levels among patients were higher and the pepsinogen I/II ratio among patients was lower than among control subjects. When a pepsinogen II level higher than 14.8 ng/ml was considered positive, the test showed high sensitivity (83.3% for total gastric carcinoma and 85.0% for early gastric carcinoma) and high specificity (76.9% for hospital control subjects and 75.0% for screening control subjects). Similar degrees of sensitivity and specificity were obtained with the pepsinogen I/II ratio.
Conclusions: These results suggest that a high pepsinogen II level combined with a low pepsinogen I/II ratio may be a useful screening test for gastric carcinoma in a young population at high risk for gastric carcinoma. This impression should be confirmed by a more extensive field trial to determine whether performance of these assays promotes early diagnosis of gastric carcinoma.