ORIGINAL RESEARCH article
Front. Med.
Sec. Gastroenterology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1570228
Combined Biomarker Analysis of Pepsinogens, Neutrophil-Lymphocyte Ratio, and Carcinoembryonic Antigen Enhances Discrimination Between Benign and Malignant Gastric Ulcers
Provisionally accepted
- Wuhan Sixth Hospital, Wuhan, China
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Background: Accurate differentiation between benign and malignant gastric ulcers remains a clinical challenge. This study evaluates the diagnostic utility of combining gastric function biomarkers (Pepsinogen I [PG I], Pepsinogen II [PG II], PGR (the ratio of PG I to PG II)), systemic inflammation (Neutrophil-Lymphocyte Ratio (NLR), the ratio of neutrophil count to lymphocyte count), and tumor-associated antigen (Carcinoembryonic Antigen, CEA) in distinguishing gastric ulcer subtypes.: A retrospective cohort of 105 gastric ulcer patients (79 benign, 26 malignant) diagnosed between January 2021 and December 2023 was compared with 60 healthy controls. Serum PG I, PG II, PGR, NLR, and CEA levels were analyzed. Multivariate logistic regression identified malignancy predictors, while ROC curves assessed diagnostic performance. Results: Malignant ulcers exhibited significantly lower PG I (t=21.950) and PGR (t=34.890), with elevated PG II (t=17.750), NLR (t=9.395), and CEA (t=29.450) versus controls (all p<0.05). Independent malignancy predictors included H. pylori infection (OR=1.874), alcohol abuse (OR=2.054), PG I reduction (OR=2.012), PG II elevation (OR=2.034), PGR decline (OR=2.106), NLR increase (OR=1.964), and CEA rise (OR=2.077). Individual biomarker AUCs ranged 0.789-0.866, while combined analysis achieved superior discrimination (AUC=0.953, p<0.05). Conclusion: Multimodal assessment of pepsinogen profiles, NLR, and CEA significantly improves diagnostic accuracy for malignant gastric ulcers, offering a clinically actionable strategy for early risk stratification.
Keywords: gastric cancer, peptic ulcer disease, Biomarker panel, systemic inflammation, early diagnosis
Received: 03 Feb 2025; Accepted: 26 May 2025.
Copyright: © 2025 Liao, Shi, Yin, Liu and Ao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Fengqin Ao, Wuhan Sixth Hospital, Wuhan, China
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