Published online Jan 14, 2027. doi: 10.3748/wjg.124537
Revised: July 22, 2026
Accepted: July 29, 2026
Published online: January 14, 2027
Processing time: 141 Days and 22.4 Hours
Serum pepsinogen (PG) is a potential biomarker for monitoring recurrence after total gastrectomy for gastric cancer (GC). Computed tomography (CT) imaging provides anatomical localization but has limited sensitivity for early recurrence. The complementary value of combining these two modalities and the impact of tumor differentiation on the diagnostic performance of PG require systematic eva
To evaluate the combined diagnostic value of serum PG and CT imaging for recurrence after total gastrectomy, and to assess the impact of histological differentiation on PG-based diagnosis.
Data from 110 patients who underwent radical total gastrectomy for GC were retrospectively analyzed. Using a comprehensive reference standard, positivity rates of serum PG levels and CT imaging for recurrence were compared. Receiver operating characteristic curves were generated to assess the individual diagnostic performance of each modality, and a combined predictive model was developed using multivariate logistic regression. Immunohistochemistry was performed to examine PG expression in tumor tissues and its relationship with histological dif
During the 1-year post-operative follow-up, recurrence was confirmed in 65 patients (59.09%). The positivity rate of serum PG was significantly higher than CT imaging overall (56.36% vs 40.00%; P = 0.0027) and in the recurrence subgroup (92.31% vs 63.08%; P = 0.0008). The area under the curve (AUC) for serum PG alone was 0.94, whereas that for CT imaging alone was 0.78. The combined logistic regression model achieved an AUC of 0.98. Both serum PG [odds ratio (OR) = 501.25; P < 0.0001] and CT imaging (OR = 58.22; P = 0.001) were independent predictors of recurrence. PG expression was higher in undifferentiated than in differentiated tumors (86.36% vs 14.29%; P = 0.0011). After excluding PG-negative differentiated recurrences, serum PG sensitivity increased from 92.31% to 98.36%.
Serum PG and CT imaging play complementary roles in functional assessment and morphological localization. Integrating these modalities with histological stratification provides a highly sensitive tool for diagnosing post-gastrectomy recurrence and supports personalized postoperative surveillance.
Core Tip: This study evaluated the combined diagnostic performance of serum pepsinogen (PG) and computed tomography (CT) imaging for detecting recurrence after total gastrectomy. We found that serum PG and CT imaging play complementary roles, with PG providing early functional warning by reflecting secretory tumor burden and CT imaging offering anatomical confirmation. Importantly, PG expression varied substantially by histological differentiation, and this heterogeneity directly influenced the diagnostic sensitivity of serum PG. These findings support a histology-stratified, PG-centered surveillance strategy that integrates functional and morphological information for personalized postoperative follow-up.