| 特集名 | 有効性評価に基づく胃がん検診ガイドライン―内視鏡検診時代の新たなる幕開け | |
|---|---|---|
| 題名 | 検診対象集約への戦略―現状と課題 (1) ペプシノゲン検査による胃癌リスク評価 | |
| 発刊年月 | 2016年 02月 | |
| 著者 | 井上 泉 | 和歌山県立医科大学第二内科 |
| 著者 | 加藤 順 | 和歌山県立医科大学第二内科 |
| 著者 | 前北 隆雄 | 和歌山県立医科大学第二内科 |
| 著者 | 井口 幹崇 | 和歌山県立医科大学第二内科 |
| 著者 | 玉井 秀幸 | 和歌山県立医科大学第二内科 |
| 著者 | 一瀬 雅夫 | 和歌山県立医科大学第二内科 |
| 【 要旨 】 | ペプシノゲン（PG）ⅠとPG IIは胃粘膜の炎症や萎縮で変動し，PGⅠおよびPGⅠ/II低値は萎縮進展度を，PG II高値は高度活動性炎症を反映する指標と理解されている．PG検査（萎縮性胃炎判定基準：PGⅠ≦70 ng/ml かつPGⅠ/II≦3.0）に基づいた胃癌リスク診断が現状では行われており，長期観察研究の結果，萎縮性胃炎進展に伴い胃癌発生リスクが段階的に上昇すること，PG検査を用いて胃癌リスク評価とハイリスク集約が可能であることが示唆された．一方で，PG陰性群に混在する胃癌ハイリスクの存在がPG検査の課題としてあり，発癌過程に基づいたPG値を指標とする具体的な胃癌リスク診断の対象集約への活用が期待される． | |
| Theme | Evidence-based Guidelines Version 2 for Gastric Cancer Screening ; The Beginning of a New Era of Endoscopic Cancer Screening | |
|---|---|---|
| Title | High Risk of Gastric Cancer Based on Serum Pepsinogen Test | |
| Author | Izumi Inoue | Depertment of Gastroenterology, Faculty of Medicine, Wakayama Medical University |
| Author | Jun Kato | Depertment of Gastroenterology, Faculty of Medicine, Wakayama Medical University |
| Author | Takao Maekita | Depertment of Gastroenterology, Faculty of Medicine, Wakayama Medical University |
| Author | Mikitaka Iguchi | Depertment of Gastroenterology, Faculty of Medicine, Wakayama Medical University |
| Author | Hideyuki Tamai | Depertment of Gastroenterology, Faculty of Medicine, Wakayama Medical University |
| Author | Masao Ichinose | Depertment of Gastroenterology, Faculty of Medicine, Wakayama Medical University |
| [ Summary ] | Subjects of extensive CAG (chronic atrophic gastritis) associated with high incidence of gastric cancer have been diagnosed based on PG (pepsinogen) test (positive criteria : PG I ≤ 70 ng/ml and PG I/II ≤ 3.0). Risk‒based assessment in gastric cancer screening by PG test enables the selection of high‒risk individuals for gastric cancer and efficient screening. However, a considerable proportion of gastric cancers were derived from PG negative subjects and major issue remains as for further stratification of PG negative group that is the detection of high‒risk subgroups for gastric cancer. Long‒term observational studies have revealed that an individual risk of gastric cancer can be assessed by the serum PG levels. Serum PG levels are considered reliable markers for CAG progression at high risk of intestinal‒type gastric cancer related to a stepwise reduction in the serum PG I level or PG I/II ratio and severity of active gastric inflammation leading to the diffuse‒type cancer correlated with high levels of PG II. Serum PG levels could be used as objective markers to differentiated individual risk for gastric cancer considering gastric carcinogenesis through two‒different pathway, and could be useful for the perspective screen‒and‒treat strategy in the prevention of gastric cancer. |
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