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Effect of Helicobacter pylori infection combined with CagA and pepsinogen status on gastric cancer development among Japanese men and women: a nested case-control study.

Abstract

BACKGROUND

Although accumulating evidence suggests that Helicobacter pylori plays a role in gastric carcinogenesis, the magnitude of the risk remains uncertain.

AIM

We aimed to estimate the magnitude of the risk of gastric cancer associated with H. pylori infection by a large case-control study nested within a prospective cohort. Possible effect modification by CagA status, and serum pepsinogen status, as a marker of atrophic gastritis, was also considered to see its effect on developing gastric cancer.

SUBJECTS AND METHODS

Subjects (n = 123,576) were followed up from 1990 to 2004; 511 gastric cancer cases matched to 511 controls were used in the analysis. Plasma immunoglobulin G antibody to H. pylori, CagA, and pepsinogen I and II were measured.

RESULTS

The adjusted odds ratio (95% confidence interval) of gastric cancer associated with H. pylori infection was 5.1 (3.2-8.0). Assuming all CagA-positive subjects are true H. pylori positives doubled this risk. Atrophic gastritis was also associated with an elevated risk of gastric cancer and the risk increased further with pepsinogen levels.

CONCLUSIONS

Subjects with pepsinogen levels indicative of severe atrophic gastritis may need careful examination regularly regardless of H. pylori infection. Those who have other pepsinogen levels but who are H. pylori seropositive are likely to benefit from H. pylori eradication therapy. Considering both the cost and the potential for misclassification that may occur using multiple serologic tests, caution is needed in interpreting or extrapolating these findings into a screening strategy.

Authors+Show Affiliations

Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Chuo-ku, Tokyo, Japan. ssasazuk@gan2.res.ncc.go.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16835334

Citation

Sasazuki, Shizuka, et al. "Effect of Helicobacter Pylori Infection Combined With CagA and Pepsinogen Status On Gastric Cancer Development Among Japanese Men and Women: a Nested Case-control Study." Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored By the American Society of Preventive Oncology, vol. 15, no. 7, 2006, pp. 1341-7.
Sasazuki S, Inoue M, Iwasaki M, et al. Effect of Helicobacter pylori infection combined with CagA and pepsinogen status on gastric cancer development among Japanese men and women: a nested case-control study. Cancer Epidemiol Biomarkers Prev. 2006;15(7):1341-7.
Sasazuki, S., Inoue, M., Iwasaki, M., Otani, T., Yamamoto, S., Ikeda, S., ... Tsugane, S. (2006). Effect of Helicobacter pylori infection combined with CagA and pepsinogen status on gastric cancer development among Japanese men and women: a nested case-control study. Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored By the American Society of Preventive Oncology, 15(7), pp. 1341-7.
Sasazuki S, et al. Effect of Helicobacter Pylori Infection Combined With CagA and Pepsinogen Status On Gastric Cancer Development Among Japanese Men and Women: a Nested Case-control Study. Cancer Epidemiol Biomarkers Prev. 2006;15(7):1341-7. PubMed PMID: 16835334.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Helicobacter pylori infection combined with CagA and pepsinogen status on gastric cancer development among Japanese men and women: a nested case-control study. AU - Sasazuki,Shizuka, AU - Inoue,Manami, AU - Iwasaki,Motoki, AU - Otani,Tetsuya, AU - Yamamoto,Seiichiro, AU - Ikeda,Shinobu, AU - Hanaoka,Tomoyuki, AU - Tsugane,Shoichiro, AU - ,, PY - 2006/7/13/pubmed PY - 2006/11/15/medline PY - 2006/7/13/entrez SP - 1341 EP - 7 JF - Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology JO - Cancer Epidemiol. Biomarkers Prev. VL - 15 IS - 7 N2 - BACKGROUND: Although accumulating evidence suggests that Helicobacter pylori plays a role in gastric carcinogenesis, the magnitude of the risk remains uncertain. AIM: We aimed to estimate the magnitude of the risk of gastric cancer associated with H. pylori infection by a large case-control study nested within a prospective cohort. Possible effect modification by CagA status, and serum pepsinogen status, as a marker of atrophic gastritis, was also considered to see its effect on developing gastric cancer. SUBJECTS AND METHODS: Subjects (n = 123,576) were followed up from 1990 to 2004; 511 gastric cancer cases matched to 511 controls were used in the analysis. Plasma immunoglobulin G antibody to H. pylori, CagA, and pepsinogen I and II were measured. RESULTS: The adjusted odds ratio (95% confidence interval) of gastric cancer associated with H. pylori infection was 5.1 (3.2-8.0). Assuming all CagA-positive subjects are true H. pylori positives doubled this risk. Atrophic gastritis was also associated with an elevated risk of gastric cancer and the risk increased further with pepsinogen levels. CONCLUSIONS: Subjects with pepsinogen levels indicative of severe atrophic gastritis may need careful examination regularly regardless of H. pylori infection. Those who have other pepsinogen levels but who are H. pylori seropositive are likely to benefit from H. pylori eradication therapy. Considering both the cost and the potential for misclassification that may occur using multiple serologic tests, caution is needed in interpreting or extrapolating these findings into a screening strategy. SN - 1055-9965 UR - https://www.unboundmedicine.com/medline/citation/16835334/Effect_of_Helicobacter_pylori_infection_combined_with_CagA_and_pepsinogen_status_on_gastric_cancer_development_among_Japanese_men_and_women:_a_nested_case_control_study_ L2 - http://cebp.aacrjournals.org/cgi/pmidlookup?view=long&pmid=16835334 DB - PRIME DP - Unbound Medicine ER -