Diagnostic Value of Serum Pepsinogen and Helicobacter pylori Infection in Gastric Cancer Screening in Western Zhejiang.

Objective The aim of this study is to assess the screening value of serum pepsinogen (PG) expression and Helicobacter pylori ( Hp ) infection for gastric cancer (GC) in western Zhejiang. Methods A retrospective analysis was conducted on patients who underwent gastroscopy at the First People′s Hospital of Jiande between July 2020 and July 2023. Participants were classified into four groups: chronic nonatrophic gastritis, chronic atrophic gastritis, peptic ulcer, and GC, which included early gastric cancer (EGC) and advanced GC. Serum pepsinogen I (PGI), pepsinogen II (PGII), pepsinogen ratio (PGR), and anti‐ Helicobacter pylori immunoglobulin G (Hp‐IgG) levels were measured. Group differences were assessed, and receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of PG alone and in combination with Hp‐IgG, age, and sex for GC and EGC. Results Significant differences were observed among the four groups in PGI, PGII, PGR, Hp infection rate, age, and sex ( p < 0.01). In benign gastric diseases, PGI and PGII levels increased with the severity and activity of gastric mucosal inflammation ( p < 0.05). PGII levels were associated with tumor size and Lauren classification ( p < 0.05), while PGR was associated with GC stage ( p = 0.021). The area under the ROC curve (AUC) for PG alone in differentiating GC/EGC from benign gastric diseases ranged from 0.598 to 0.813, whereas the model incorporating PG, Hp‐IgG, age, and sex achieved an AUC of 0.851. Conclusion Serum PG expression and Hp infection rates differed between patients with GC and those with benign gastric diseases in western Zhejiang. Models combining PG with demographic variables demonstrated a good diagnostic value for GC, including EGC, supporting their potential application in noninvasive GC screening.