PT  - JOURNAL ARTICLE
AU  - Con, Sergio A.
AU  - Con-Wong, Reinaldo
AU  - Con-Chin, Gil R.
AU  - Con-Chin, Vicky G.
AU  - Takeuchi, Hiroaki
AU  - Valerín, Ana L.
AU  - Echandi, Guillermo
AU  - Mena, Fernando
AU  - Brenes, Fernando
AU  - Yasuda, Nobufumi
AU  - Araki, Keijiro
AU  - Sugiura, Tetsuro
TI  - Serum Pepsinogen Levels, <em>Helicobacter pylori</em> CagA Status, and Cytokine Gene Polymorphisms Associated with Gastric Premalignant Lesions in Costa Rica
AID  - 10.1158/1055-9965.EPI-07-0215
DP  - 2007 Dec 01
TA  - Cancer Epidemiology Biomarkers & Prevention
PG  - 2631--2636
VI  - 16
IP  - 12
4099  - http://cebp.aacrjournals.org/content/16/12/2631.short
4100  - http://cebp.aacrjournals.org/content/16/12/2631.full
SO  - Cancer Epidemiol Biomarkers Prev2007 Dec 01; 16
AB  - The detection of gastric premalignant lesions, atrophic gastritis, corpus atrophic gastritis, and intestinal metaplasia, using several potential markers was examined in Costa Rica. Depending on the lesion investigated, from a total of 223 dyspeptic patients, 58 (26.0%), 31 (13.9%), or 23 (10.3%) were histologically diagnosed with atrophic gastritis, corpus atrophic gastritis, or intestinal metaplasia, respectively. Sera were used for the measurement of pepsinogen (PG) and Helicobacter pylori CagA antibody (CagA-ab) levels by ELISA, and human genomic DNAs were used for the genotyping of interleukin (IL)-1β (−511 and +3954), IL-10 (−1082 and −592), and IL-1RN intron 2 by PCR and RFLP. Multivariate analysis was done adjusting for sex, age, and H. pylori seropositivity. Low PG levels (L-PG; PG I ≤70 μg/L + PG I/II ≤3), very low PG levels (VL-PG; PG I ≤30 μg/L + PG I/II ≤2), and CagA-ab were individually associated with all premalignant lesions whereas IL-1β +3954T-carrier and IL-1RN homozygous 2 allele were associated with intestinal metaplasia. VL-PG, for corpus atrophic gastritis detection, was the single marker with the highest combination of test characteristics, sensitivity (77.4%), specificity (80.7%), positive predictive value (39.3%), negative predictive value (95.7%), and seropositivity rate (27.4%), expected to improve after periodic measurements. Combined examinations of VL-PG and CagA-ab improved the specificity (92.7%) and positive predictive value (62.2%), with similar sensitivity (74.2%) and negative predictive value (95.7%). In conclusion, corpus atrophic gastritis detection with periodic measurements of serum PG, alone or in combination with CagA-ab status, to identify high gastric cancer risk, seems to be the method best suited for mass screening in Costa Rica. (Cancer Epidemiol Biomarkers Prev 2007;16(12):2631–6)