The Association Between Helicobacter Pylori Infection, Serum Pepsinogens And Gastrin-17 And Noncardia Gastric Cancer, Cardia Cancer And Esophageal Cancers: A Prospective Study In Linxian, Henan Province

Background:Recent studies have suggested that Helicobacter pylori(Hp) infection is important risk factor for Chronic Atrophic Gastritis(CAG) and gastric cancer,serum pepsinogens(PG) and Gastrin-17(G17) are reliable serum markers of gastric atrophy.At present,studies on the association of these serum markers and gastric cancer are mainly cross-sectional or retrospective,and usually combined gastric non-cardia cancer(GNCC) and gastric cardia cancer(GCC) together. Considering GCC is different from GNCC on the diagnosis,carcinogenesis and treatment.It is necessary to investigate the association of these serum markers and these two types of cancers separately.Up to now,the association of these serum markers and GCC is not very clear.Recently several case control studies reported that low serum PGⅠand PGⅠ/Ⅱratio(PGR) might increase the risk of Esophageal Squamous Cell Carcinoma(ESCC). However,these studies concluded deficient cases and lacked time sequence. Well-designed,large size,prospective study is warranted to confirm the association of serum PGⅠand PGR and ESCC.Objectives:To investigate the association of Hp infection,serum PG and G17 and GNCC,GCC and ESCC,providing more scientific evidences on the etiology and prevent and control measures for these cancers.Materials and Methods:We conducted a case cohort study.Cases and controls were selected from the General Population of Nutrition Intervention Trial(NIT) and the follow up cohort.Firstly,we selected an adequate random sample from baseline cohort.Based on the data to May,2001,we selected three random samples from the diagnosed GNCC,GCC and ESCC cases to form corresponding case groups.Baseline serum Hp IgG antibodies,PGⅠ,PGⅡ,and G17 were measured using enzyme-linked immunosorbent assay(ELISA).Distribution characters of Hp infection,serum PGⅠ, PGⅠ/Ⅱratio and G17 were described.Cox regression models were used to calculate adjusted hazard ratios(HR) and 95%confidence intervals(95%CI).Results:1.Compared with entire cohort,subcohort has more smokers in males.There is no difference of character distribution between three case groups and corresponding whole cases.2.Among subcohort group subjects,73.20%participants were infected with Hp; serum PGⅠ,PGR and G17 medians are 117.59μg/L,8.58 and 3.03pmol/L respectively.3.Hp infection,low PGⅠ(cutoff=80μg/L),low PGR(cutoff=6) and low G17(cutoff= 2pmol/L) are risk factors for GNCC,adjusted HRs(95%CI) are 1.53(1.13-2.13),2.24 (1.54-3.26),2.07(1.54-2.77) and 1.48(1.12-1.95) respectively.4.Hp infection and low serum PGR are the risk factors of GCC,adjusted HRs (95%CI) are 1.63(1.25-2.13) and 1.70(1.33-2.17) respectively.Low serum PGⅠand low serum G17 are not the risk factors of GCC.5.Hp infection is not the risk factors of ESCC.Low serum PGⅠcombined with low serum PGR is the risk factor of ESCC,adjusted HR(95%CI) is 1.68(1.01-2.78).Low serum G17(cutoff=0.5pmol/L) increase the risk of ESCC,adjusted HR(95%CI) is 1.36(1.01-1.83).Conclusions:1.Random samples are well representative.The serum markers distribution characters of entire cohort can be deduced through randomly selected samples.2.Hp infection is common among subcohort participants and influences the level of serum PGⅠ,PGR and G17.3.Hp infection,low serum PGⅠ,PGR and G17 can increase the risk of GNCC.These serum markers could be used to identify the high risk population of GNCC. 4.Hp infection and low serum PGR can increase the risk of GCC Linxian residents.5.Low serum PGⅠ,PGR and G17 are weak risk factors for ESCC.Further study on the association of these serum markers and ESCC is warranted.