The Association of Trefoil Factors with Gastric Cancer and Premalignant Lesions: A Cross-Sectional Population-Based Cohort Study

Background: A lack of research on the association of trefoil factors (TFF) with gastric cancer and premalignant lesions (PML) in the general population is an important obstacle to the application of TFFs for gastric cancer screening. We aimed to analyze the association of TFFs with gastric cancer and PMLs in a general population. Methods: We evaluated 3,986 adults residing in Wuwei, China. We collected baseline characteristics and gastric cancer risk factors, including TFFs, endoscopic diagnosis, and pathologic information. Three logistic regression models were generated to analyze the association between TFFs and gastric cancer, as well as PMLs. Adjusted odds ratio (OR) and 95% confidence intervals (95% CI) were calculated to determine the strength of association. Results: Compared with pepsinogen (PG) and anti–Helicobacter pylori immunoglobulin G antibody (Hp-IgG), TFFs had significant association with gastric cancer and PMLs after adjusting for biomarkers and risk factors (P < 0.05). The ORs (95% CI) for TFF1 (1.67; 1.27–2.20), TFF2 (2.66; 2.01–3.51), and TFF3 (1.32; 1.00–1.74) were larger than the ORs for PGI (0.79; 0.61–1.03), PGI/II (1.00; 0.76–1.31), and Hp-IgG (0.99; 0.73–1.35) in the gastric cancer group. In the intestinal metaplasia (IM) group, not only the TFF3 serum level was the highest, but also the OR (1.92; 1.64–2.25) was the highest. Conclusions: TFFs were associated with risk of gastric cancer and PMLs. Impact: Serum TFFs can improve the screening of high-risk populations for gastric cancer.