The serum pepsinogen test as a predictor of gastric cancer: the Hisayama study

Am J Epidemiol. 2006 Apr 1;163(7):629-37. doi: 10.1093/aje/kwj088. Epub 2006 Jan 27.


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 > or =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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Helicobacter Infections / epidemiology
  • Helicobacter pylori
  • Humans
  • Incidence
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Pepsinogens / blood*
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Regression Analysis
  • Risk Factors
  • Seroepidemiologic Studies
  • Stomach Neoplasms / blood
  • Stomach Neoplasms / epidemiology*
  • Stomach Neoplasms / microbiology


  • Pepsinogens