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Serum pepsinogen assay is not recommended for the diagnosis of esophageal squamous cell carcinoma: a systematic review and meta-analysis

Authors Liu XB, Gao ZY, Zhang QH, Jin S, Gao B, Yang GL, Li SB

Received 2 December 2018

Accepted for publication 16 May 2019

Published 27 June 2019 Volume 2019:11 Pages 5643—5654


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Antonella D'Anneo

Xiao-Bo Liu,1* Zi-Ye Gao,2* Qing-Hui Zhang,1* Shu Jin,1 Bo Gao,3 Gong-Li Yang,4 Sheng-Bao Li1

1Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, People’s Republic of China; 2Department of Oncology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, People’s Republic of China; 3Department of Laboratory Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, People’s Republic of China; 4Department of Gastroenterology, Shenzhen University General Hospital, Shenzhen, Guangdong 518000, People’s Republic of China

*These authors contributed equally to this work

Background: Serum pepsinogen I (PGI) concentration and PGI/PGII ratio (PGR) are often used as serological markers for gastric fundus atrophy (AGA) and gastric carcinoma. However, their diagnostic value in esophageal carcinoma (EC) is inaccurate.
Methods: This study evaluated the diagnostic value of PGI and PGR in EC by searching the PubMed, Web of Science, Embase, Cochrane Library and Cochrane Central Register of Controlled Trials databases for literature on the diagnosis of EC with PGI and PGR from January 1, 2000 to October 2, 2018. The included literature were systematically evaluated using QUSDAS-2 software. Meta-analysis was conducted using STATA 15.0 software. The summary receiver operating characteristic curve (SROC) accuracy was plotted, the area under the curve was calculated.
Results: A total of 84 papers were selected, and after screening, nine papers on esophageal squamous cell carcinoma (ESCC) were finally included. Results showed low an ESCC-specific diagnostic sensitivity (0.27), high specificity (0.85), and 0.63 AUC of SROC when PGI≤70 ng/mL. When PGR≤3, the ESCC-specific diagnostic sensitivity was low (0.29), the specificity was high (0.83), and the AUC of SROC was 0.63.
Conclusion: According to the current research results, PGI≤70 ng/mL or PGR≤3 diagnostic ESCC sensitivity is low, and specificity is high. These findings indicate that neither PGI≤70 ng/mL nor PGR≤3 can be used as an ESCC-screening index.

Keywords: esophageal squamous cell carcinoma, PGI, PGR, diagnosis, meta-analysis

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