Age-Specific Gastric Cancer Risk Indicated by the Combination of Helicobacter pylori Sero-Status and Serum Pepsinogen Levels

Authors
Sana Eybpoosh
Yeganeh Talebkhan
Samaneh Saberi
Maryam Esmaeili
Akbar Oghalaie
Fatemeh Ebrahimzadeh
Toktam Karimi
Afshin Abdirad
Azin Nahvijou
Mohammad Ali Mohagheghi
Mahmoud Eshagh Hosseini
Marjan Mohammadi
10.7508/ibj.2015.03.002
Abstract
Background: Serologic screening of gastric cancer (GC) by serum pepsinogens (sPG) levels and Helicobacter pylori (Hp) sero-status, though highly informative, has provided heterogeneous results. Here, we have evaluated the modifying effects of demographic factors on the risk impact of Hp sero-status/sPG levels in gastric cancer, with particular emphasis on age. Methods: A cross-sectional study was carried out on 1341 individuals (GC = 578, healthy = 763), who were stratified into two age groups: 35-59 years (middle-aged, n = 830) and &ge 60 years (60 years-plus, n = 511). Demographic factors and serological states (Hp sero-staus and sPG levels) were recorded by subject interview and serum ELISAs, respectively. Covariate-specific odds ratios were calculated by multivariable logistic regression. Results: Hp infection was consistently associated with increased sPGI and sPGII levels in the 60 year-plus, but not the middle-aged group. The joint examination of the variable states of the three serum biomarkers (Hp serology, sPGI, and sPGI/II ratio), in the 60 year-plus age group, demonstrated a stepwise escalation of risk from the single (sPGIlow OR = 2.6), to double (sPGIlow/sPGI/IIlow OR = 3.55, and Hppositive/sPGIlow OR=5.0) and ultimately triple (Hppositive/PGIlow/PGI/IIlow OR=10.48) positive states, in reference to the triple negatives. However, this pattern was not exhibited in the middle-aged subjects. Conclusion: Age was clearly identified as a modifying factor on the risk projection of the combined states of Hp serology and sPG levels in gastric cancer screening, reflected by the augmented (~10.5 fold) risk of GC in the triple positive (Hppositive/sPGIlow/sPGI/IIlow) 60 year-plus subjects, which was not evident in the middle-aged group.
Keywords
Biomarkers
demography
Age distribution