Serum pepsinogens and risk of gastric and oesophageal cancers in the General Population Nutrition Intervention Trial cohort.

Objective: Low serum pepsinogen I (PGI) and low pepsinogen I/pepsinogen II ratio (PGI/II ratio) are markers of gastric fundic atrophy. We aimed to prospectively test the association between serum PGI/II ratio and risks of gastric non-cardia adenocarcinoma, gastric cardia adenocarcinoma, and oesophageal squamous cell carcinoma (OSCC).

Design: Case-cohort study nested in a prospective cohort with over 15 years of follow-up.

Setting: Rural region of the People's Republic of China.

Subjects: Men and women aged 40-69 years at study baseline.

Main Outcome Measures: Adjusted hazard ratios and 95% confidence intervals for the association between serum PGI/II ratio and cancer risk.

Results: Compared to subjects with PGI/II ratio of >4, those with
Conclusion: In this prospective study, we found similar and significantly increased risks of non-cardia and cardia gastric adenocarcinomas in subjects with low PGI/II ratio but little evidence for an association with the risk of OSCC.