APR 10, 2018 05:00 PM PDT

Gastric Cancer Screening Tool Using Serum Biomarkers Being Studied in South Korea

A new study focused on Gastric Cancer (GC) is evaluating a diagnostic screening tool utilizing a serum biomarker test panel which includes pepsinogen, H. pylori IgG, and Trefoil factor 3 (TFF3).  An additional outcome is to investigate the ideal timeframe intervals for performing GC screening endoscopies in South Korea. 

The observational study is still recruiting patients and aims to have their analysis completed by 2022.  The study is designed to survey newly diagnosed GC patients and a healthy control group.  There are multiple centers involved in the study and recruitment of patients.  As reported by the researchers in the clinical trial documentation, Korea has the highest incidence of GC; their focus is to help determine factors that will provide early diagnoses which have a more favorable prognosis.  There are multiple factors that increase the risk of gastric cancer including age, gender, genetics, family history, race, obesity, smoking, and H. pylori infection history.

There is an acknowledged precancerous cascade of changes resulting in GC.  GC traditionally begins with intestinal metaplasia which is recognized as a precancerous change.  The mucosa of the stomach lining yields initially to inflammation and is followed by damaging intestinal metaplasia (usually found as result of Helicobacter pylori infection).  Normal gastric mucosa is replaced by intestinal cells with partial or complete loss of the molecular features of gastric cells in the lesion location. 

The search for accurate, less invasive and expensive testing is an important and valid endeavor for all conditions, especially for cancer.  Current testing and screening includes serum pepsinogen (PG 1, PG II, and PG I/II ratio) which is reported to be a marker of mucosal atrophy; low values have consistently been found in GC patients.  Mucosal atrophy is often a strong indicator that a precancerous state is developing.  However, there are other possibilities for reduced levels of PG I or PG II.  This study looks to add TFF3 testing; TFF3 is a secretory protein expressed in gastrointestinal mucosa.  Recently published literature found with 73.4% sensitivity and 92% specificity that the optimal cutoff value of serum TFF3 was >8.9 ng/mL for GC diagnosis.  Another group recommended a TFF3 cutoff value of 3.6 ng/mL with 80.9% sensitivity and 81% specificity.  Of note, herein lies a challenge of determining appropriate reference ranges or cutoffs for diagnosis.  TFF3 also identified diffuse-type GC at 68.0% and 92.0% respectively. TFF3 is potentially a more stable marker than the serum PG test which had a 69.6% sensitivity and 68% specificity.  H. pylori serology, while not specifically outlined in the trial information, can be stratified by the degree of mucosal atrophy.  Reportedly the population in East Asia, Eastern Europe and parts of Central and South America have high seropositive H. pylori antibody rates so using this alone as a screening tool will have very low specificity for GC or precancerous change detection.  Including PG levels as a predictor combined with H. pylori seropositivity increases that specificity.  Combining pepsinogen, H. pylori IgG, and TFF3 values into a new diagnostic guide together could improve gastric cancer screening.  

Sources: NIH US. National Library of Medicine, Clinical and Experimental Medicine, Gut Liver Journal, Gastroenterology, Gastroenterology and Hepatology Journal, Disease Markers,

About the Author
  • Mauri S. Brueggeman is a Medical Laboratory Scientist and Educator with a background in Cytogenetics and a Masters in Education from the University of Minnesota. She has worked in the clinical laboratory, taught at the University of Minnesota, and been in post secondary healthcare education administration. She is passionate about advances and leadership in science, medicine, and education.
You May Also Like
JUL 31, 2018
Cancer
JUL 31, 2018
Protein Regulation of DNA Replication in Cancer Cells - A New Early Target for Broad Therapeutics?
DNA replication is a carefully regulated process in each cell of the body. Researchers are looking at the mechanism of DNA replication and associated proteins as a therapy target in cancer...
AUG 26, 2018
Cancer
AUG 26, 2018
Can antireflux surgery prevent Esophageal cancer?
Heartburn or gastroesophageal reflux disease (GERD) is a widespread health problem affecting 10 to 20% of adults in Western populations. If GERD left untre...
SEP 26, 2018
Videos
SEP 26, 2018
Cancer Immunotherapy
Video illustration about how tumor cells are sensed and destroyed by the immune system and how tumors evolve and detect immune-mediated eliminations, as well as iimmunotherapies associated....
SEP 26, 2018
Cancer
SEP 26, 2018
Rare Cancer the Focus of Mesothelioma Awareness Day
More than 2,500 Americans are diagnosed with mesothelioma cancer each year. The cancer is rare but very serious - most patients diagnosed with the disease live just a short 12 to 21 months....
OCT 14, 2018
Immunology
OCT 14, 2018
The Stem of Cancer
Scientists reveal a pathway involved in cancer cell ability to act as stem cells...
NOV 12, 2018
Health & Medicine
NOV 12, 2018
Researchers find that obesity has a paradoxical effect on Cancer
Cancer therapy works differently in different people. Understanding what effects the individual body's response to treatment will be crucial for the development...
Loading Comments...