Prediction of gastric cancer development by serum pepsinogen test and Helicobacter pylori seropositivity in Eastern Asians: a systematic review and meta-analysis.
Prediction of gastric cancer development by serum pepsinogen test and Helicobacter pylori seropositivity in Eastern Asians: a systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0109783
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Hamashima C
中科院分区：
文献类型：
--
作者：
Terasawa T;Nishida H;Kato K;Miyashiro I;Yoshikawa T;Takaku R;Hamashima C
为了在假定健康的人群中识别胃癌高危人群，一些研究调查了胃蛋白酶原试验、H。幽门螺杆菌抗体，以及基于这两种测试的风险预测模型。为了研究这些检测是否能准确预测胃癌的发展，我们进行了一项系统回顾和荟萃分析。检索PubMed和其他电子数据库中1985年1月至2013年12月期间以英语或日语发表的队列研究。六名评审员确定了合格的研究，至少有两名研究人员提取了有关人群和研究设计特征、质量项目和感兴趣结果的数据。对非重叠研究进行荟萃分析。12篇出版物中报告的来自东亚的9个前瞻性队列，包括33，741名胃癌筛查的无症状中年参与者，符合条件。为了区分胃癌高风险和低风险的无症状成人，胃蛋白酶原试验（汇总风险比[HR]，3.5; 95%置信区间[CI]，2.7-4.7; I2 = 0%）和H. 作为独立检验，幽门螺杆菌抗体（汇总HR，3.2; 95% CI，2.0-5.2; I2 =0%）是统计学显著性预测因子。 虽然风险预测模型在将无症状成人分为四个风险组方面一般具有中等准确性（汇总c统计量，0.71; 95%CI：0.68-0.73; I2 = 7%），但校准似乎较差。 研究的有效性通常是有限的。血清胃蛋白酶原试验、H.幽门螺杆菌抗体和预测胃癌发展的四个风险组模型似乎有可能对中年健康成年人进行分层。未来的研究需要集中在比较研究，以评估采用这些测试的筛查计划的影响。此外，验证，最好是模型更新，是必要的，看看目前的模型性能是否可以转移到不同的人群。
To identify high-risk groups for gastric cancer in presumptively healthy populations, several studies have investigated the predictive ability of the pepsinogen test, H. Pylori antibodies, and a risk-prediction model based on these two tests. To investigate whether these tests accurately predict gastric cancer development, we conducted a systematic review and meta-analysis. PubMed and other electronic databases were searched for cohort studies published in English or Japanese from January 1985 through December 2013. Six reviewers identified eligible studies, and at least two investigators extracted data on population and study-design characteristics, quality items, and outcomes of interest. Meta-analyses were performed on non-overlapping studies. Nine prospective cohorts from Eastern Asia reported in 12 publications, including 33,741 asymptomatic middle-aged participants of gastric cancer screening, were eligible. For discriminating between asymptomatic adults at high and low risk of gastric cancer, the pepsinogen test (summary hazard ratio [HR], 3.5; 95% confidence interval [CI], 2.7–4.7; I2 = 0%) and H. pylori antibodies (summary HR, 3.2; 95% CI, 2.0–5.2; I2 = 0%) were statistically significant predictors as standalone tests. Although the risk-prediction model was in general moderately accurate in separating asymptomatic adults into four risk groups (summary c-statistic, 0.71; 95% CI: 0.68–0.73; I2 = 7%), calibration seemed to be poor. The study validity was generally limited. The serum pepsinogen test, H. pylori antibodies, and the four-risk-group model for predicting gastric cancer development seem to have the potential to stratify middle-aged presumptively healthy adults. Future research needs to focus on comparative studies to evaluate the impact of screening programs adopting these tests. Also, validation, preferably with model updating, is necessary to see whether the current model performance is transferable to different populations.
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