Evaluation of serum markers for gastric cancer and its precursor diseases among high incidence and mortality rate of gastric cancer area.

BACKGROUND: Mongolia has the highest mortality rate of gastric cancer. The early detection of cancer and down-staging screening for high risk patients are essential. Therefore, we aimed to validate serum markers for stratifying patients for further management. METHODS: Endoscopy and histological examination were performed to determine high risk and gastric cancer patients. Rapid urease test, culture and histological tests were performed to diagnose Helicobacter pylori infection. Serum pepsinogen (PG) I and II and anti-H. pylori IgG were measured by ELISA. Receiver Operating Characteristic analysis was used to extract the best cut-off point. RESULTS: Totally 752 non-cancer and 50 consecutive gastric cancer patients were involved. The corpus chronic gastritis (72%: 36/50 vs. 56.4%: 427/752), corpus atrophy (42.0%: 21/50 vs. 18.2%: 137/752) and intestinal metaplasia (IM) (64.0%: 32/50 vs. 21.5%: 162/752) were significantly higher in gastric cancer than non-cancer patients, respectively. Therefore, corpus chronic gastritis, corpus atrophy and IM were considered as high risk disease. The best serum marker to predict the high risk status was PGI/II < 3.1 (sensitivity 67.2%, specificity 61%) and PGI/II further reduced to < 2.2 (sensitivity 66%, specificity 65.1%) together with PGI < 28 ng/mL (sensitivity 70%, specificity 70%) were the best prediction for gastric cancer. The best cut-off point to diagnose H. pylori infection was anti-H. pylori IgG > 8 U/mL. Multivariate analysis showed that anti-H. pylori IgG > 8 U/mL and PGI/II < 3.1 increased risk for high risk status and PGI/II < 3.1 remained to increase risk for gastric cancer. CONCLUSION: The serum diagnosis using PGI/II < 3.1 cut-off value is valuable marker to predict high risk patients for population based massive screening.

New observations regarding Helicobacter pylori and gastric cancer in Mongolia.

BACKGROUND: The incidence and mortality of gastric cancer in Mongolia is among the highest in the world. METHODS: This was a case-control study in which upper gastrointestinal endoscopy, gastric histology, Helicobacter pylori testing, and risk factor questionnaires were obtained. Histologic subtypes were determined by Lauren's classification. RESULTS: We enrolled 45 gastric cancer and 108 non-gastric cancer patients. Gastric cancers were located in upper part of stomach in 53.3%, main gastric body in 37.8%, and lower part of stomach in 8.9%. The majority (60%) were diffuse type, followed by intestinal type (36.7%) and indeterminate type (3.3%). H. pylori infections were CagA positive in 100% with cancer vs 81% without cancer (P = .02). The majority of CagA was non-East Asian type (95% with cancer and 94.1% without cancer). Cancer patients had typically related with excessive use of salt, hot beverages, tobacco smoking, and low ingestion of fruits. CONCLUSION: The characteristic topography of gastric cancer in Mongolia being in the gastric corpus differed from East Asian countries and was more similar to western countries. The risk factors for gastric cancer in Mongolia were similar to other high-risk areas (ie, H. pylori infection, excessive use of salt, tobacco smoking, and low ingestion of fruits).

Hepatocellular carcinoma and its early detection by AFP testing in Mongolia.

Liver cancer is one of the leading causes of cancer death in Mongolia. Since 1982-1986 , when HCC became the most frequent cancer among the Mongolian population, the rate has been increasing continuously. In the period 2000-2005 years 35.3%of all newly registered cancer cases were liver cancers, with an incidence rate of 51.3 per 100,000 population. Compared to the previous 5 year period, the rate increased by 11%. The objective here was to analyze hepatitis B (HBV) and C virus (HCV)-related HCC cases and to evaluate the possibility of tumor marker (AFP) testing for early detection in Mongolia. Sera from a total of 513 patients with chronic liver diseases, liver cirrhosis and HCC were analyzed for liver function (ALAT, ASAT) and hepatitis virus markers (HBsAg, anti-HCV). Sera from 316 patients were also examined for alpha-fetoprotein (AFP) levels. The overall incidence of HBsAg or anti-HCV were very high ( 95.3%) among all patients. Some 33.5% (66/197) of patients with HCC were positive for HBsAg and 45.2% (89/197) for anti-HCV. Moreover, 17.3% ( 34/197) of HCC patients demonstrated co-infection with HBV and HCV. AFP levels were elevated in 4.6% (11/238) and 29.5% (23/78) of chronic hepatitis and cirrhosis patients, respectively. In HCC cases, 84.3% (166) of patients had increased level of AFP ranging from 32 ng/ml to more than 400 ng/ml. We conclude that HBV/HCV infection is the main factor related to development of HCC in Mongolia and that testing for AFP serum levels is a useful tool for early detection and diagnosis.

High frequency of hepatocellular carcinoma in Mongolia; association with mono-, or co-infection with hepatitis C, B, and delta viruses.

To investigate the association between viral infection pattern and hepatocellular carcinoma (HCC), 292 chronic hepatitis patients, including 108 with developed HCC were screened using serological and molecular genetics methods. Viral etiology was established in 267 (91.4%), anti-HCV detected in 198 (67.8%), and HBsAg in 124 (42.5%) including 93 (74.4%) cases with HDV co-infection. HCV mono-infection predominated in both, "non-HCC" and "HCC" groups (54% and 39%, respectively) with higher frequency in the first group (P = 0.011), whereas HBV in co-infection with HDV was more frequent in HCC group (14% vs 25%, P = 0.017). Patients with HCV mono-infection were older than those with co-infection (P<0.02), had higher frequency of HCV-viraemia (82% vs 7%, P < 0.0001), and yet had significantly lower prevalence of HCC (29.6% vs. 49.1%, P = 0.003). Alpha-fetoprotein (AFP) and protein induced by vitamin K antagonist-II (PIVKA-II) were specifically elevated in 71% of HCC patients. In conclusion, although HCV monoinfection pattern predominates in Mongolia, co-infection with HBV and HDV had stronger association with HCC development at younger age. Liver tumor markers; AFP and PIVKA-II are useful tools for complex HCC-screening and clinical follow-up for chronic hepatitis patients in Mongolia.