Open Access Research article

Serum trefoil factor 3 is a promising non-invasive biomarker for gastric cancer screening: A monocentric cohort study in China

Zhigang Huang1*, Xie Zhang1, Hongna Lu1, Lina Wu1, Danping Wang3, Qiubo Zhang1 and Huaxin Ding2

Author Affiliations

1 Department of Gastroenterology, Lihuili Hospital of Ningbo Medical Center, 57# Xingning Road, Ningbo 315000, China

2 Ningbo Diagnostic Pathology Center, 2# Guanghua Road, Ningbo 315000, China

3 Ningbo University, 818# Fenghua Road, Jiangbei District, Ningbo 315000, China

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BMC Gastroenterology 2014, 14:74  doi:10.1186/1471-230X-14-74

Published: 11 April 2014



The search for better non-invasive biomarkers for gastric cancer remains ongoing. We investigated the predictive power of serum trefoil factor (TFF) levels as biomarkers for gastric cancer in comparison with the pepsinogen (PG) test.


Patients with gastric cancer, chronic atrophic gastritis (CAG) or chronic non-atrophic gastritis (CNAG), and healthy people were recruited. Serum concentrations of TFFs, PG I, and PG II, as well as the presence of antibodies against Helicobacter pylori, were measured by enzyme-linked immunosorbent assays (ELISA). Receiver operating characteristics (ROC) were used to compare the predictive powers of the selected factors.


The serum concentrations of TFF1, TFF2, and TFF3 in the control groups were significantly lower than those in the gastric cancer group with the exception of TFF2 which was elevated in CAG. The area under the ROC curve for TFF3 was greater than that for the PG I/II ratio (0.81 vs 0.78). TFF3 also had a significantly higher predictive power for distinguishing gastric cancer than the PG test (odds ratio: 10.33 vs 2.57). Moreover, combining the serum TFF3 and PG tests for gastric cancer had better predictive power than either alone.


Serum TFF3 may be a better predictor of gastric cancer than the PG test, while the combined testing of serum PG and TFF3 could further improve the efficacy of gastric cancer screening.

Gastric cancer; Diagnosis; Serum trefoil factors; Pepsinogen