Comparison of the Validity of Three Biomarkers for Gastric Cancer Screening Carcinoembryonic Antigen, Pepsinogens, and High Sensitive C-reactive Protein

Purpose: To identify a desirable serum marker for screening tools for gastric cancer, we evaluated the validity of 3 biomarkers, namely, carcinoembryonic antigen (CEA), pepsinogens (PGs), and high sensitive C-reactive protein (hsCRP). Methods: We estimated the mean serum levels of CEA, PGs, and hsCRP and compared the sensitivity and specificity of these 3 biomarkers in 378 subjects who were classified into 7 groups: normal, chronic atrophic gastritis, intestinal metaplasia, adenoma, early gastric cancer (EGC), advanced gastric cancer (AGC) without metastasis, and AGC with metastasis (M-1). Results: There were no significant differences among the normal, high-risk (chronic atrophic gastritis, intestinal metaplasia, and adenoma), and EGC groups for CEA and hsCRP. However, the levels of CEA were relatively higher in the AGC group with intestinal-type cancer (P < 0.01). Likewise, hsCRP was relatively higher in the AGC group with diffuse-type cancer (P < 0.01). For the PG I II ratio, there was no significant difference among the normal, high-risk, and cancer groups, including EGC (P < 0.01). In addition, there was a negative correlation with grades (gamma(s) = -0.480, P < 0.01). However, the PG I/II ratio was relatively less effective in diffuse-type cancere compared with intestinal-type cancer. The combination of serum hsCRP and the PG I/II ratio had a higher sensitivity (77%) than did the PG I/II ratio alone (61%) in diffuse-type cancers. Conclusions: The combination of serum hsCRP adn PG I/II ratio would be helpful as a screening tool for gastric cancer in high incidence populations and may help to select high-risk subjects in need of further specific invasive screening tools such as endoscopy.