Journal Article

Development and validation of a prediction rule for estimating gastric cancer risk in the Chinese high-risk population: a nationwide multicentre study

Ye, Liping, Cai, Quancai, Zhu, Xuqing, Du, Zhiqiang, Hao, Yingxia, Lv, Nonghua, Li, Zhaoshen, Lao, Bo, Yang, Xiaocui, Li, Yumei, Yuan, Yuan, Feng, Qi, Zhou, Jianfeng, Pan, Jie, Ling, Ansheng, Li, Mingquan, Liu, Baozhen, Zhu, Chunping, Du, Yiqi, Liu, Chengxia, Li, Xiuling, Zhang, Shengsheng, Chen, Honghui, Li, Jichang, Liu, Qi, Zhang, Kaiguang, Feng, Yichao, Xu, Ping, Li, Rongzhou, Ye, Guoliang

2019

Overview

ObjectiveTo develop a gastric cancer (GC) risk prediction rule as an initial prescreening tool to identify individuals with a high risk prior to gastroscopy.DesignThis was a nationwide multicentre cross-sectional study. Individuals aged 40–80 years who went to hospitals for a GC screening gastroscopy were recruited. Serum pepsinogen (PG) I, PG II, gastrin-17 (G-17) and anti-Helicobacter pylori IgG antibody concentrations were tested prior to endoscopy. Eligible participants (n=14 929) were randomly assigned into the derivation and validation cohorts, with a ratio of 2:1. Risk factors for GC were identified by univariate and multivariate analyses and an optimal prediction rule was then settled.ResultsThe novel GC risk prediction rule comprised seven variables (age, sex, PG I/II ratio, G-17 level, H. pylori infection, pickled food and fried food), with scores ranging from 0 to 25. The observed prevalence rates of GC in the derivation cohort at low-risk (≤11), medium-risk (12–16) or high-risk (17–25) group were 1.2%, 4.4% and 12.3%, respectively (p<0.001).When gastroscopy was used for individuals with medium risk and high risk, 70.8% of total GC cases and 70.3% of early GC cases were detected. While endoscopy requirements could be reduced by 66.7% according to the low-risk proportion. The prediction rule owns a good discrimination, with an area under curve of 0.76, or calibration (p<0.001).ConclusionsThe developed and validated prediction rule showed good performance on identifying individuals at a higher risk in a Chinese high-risk population. Future studies are needed to validate its efficacy in a larger population.

• Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adult / Aged / Aged, 80 and over / Antibodies, Bacterial - blood / Biomarkers / Biomarkers, Tumor - blood / Blood tests / Clinical medicine / Colorectal cancer / Diet - adverse effects / Early Detection of Cancer - methods / Endoscopy / Family medical history / Female / Gastric cancer / Gastrin / gastrin-17 / Gastrins - blood / Gastroenterology / Gastroscopy / Helicobacter Infections - complications / Helicobacter pylori / Helicobacter pylori - immunology / Humans / Immunoglobulin G / Infections / Male / Mass Screening - methods / Medical screening / Middle Aged / Mortality / pepsinogen / Pepsinogen A - blood / Pepsinogen C - blood / Population / Population studies / Predictive Value of Tests / prescreening / Prostate / Random Allocation / Reproducibility of Results / Risk Factors / risk stratification / Secondary Prevention - methods / Sex ratio / Smoking / Stomach / Stomach Neoplasms - diagnosis / Stomach Neoplasms - etiology / Studies / Systematic review