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

Quancai Cai, Chunping Zhu, Yuan Yuan, Qi Feng, Yichao Feng, Yingxia Hao, Jichang Li, Kaiguang Zhang, Guoliang Ye, Liping Ye, Nonghua Lv, Shengsheng Zhang, Chengxia Liu, Mingquan Li, Qi Liu, Rongzhou Li, Jie Pan, Xiaocui Yang, Xuqing Zhu, Yumei Li, Bo Lao, Ansheng Ling, Honghui Chen, Xiuling Li, Ping Xu, Jianfeng Zhou, Baozhen Liu, Zhiqiang Du, Yiqi Du, Zhaoshen Li, Gastrointestinal Early Cancer Prevention & Treatment Alliance of China (GECA), Quancai Cai, Chunping Zhu, Yuan Yuan, Qi Feng, Yichao Feng, Yingxia Hao, Jichang Li, Kaiguang Zhang, Guoliang Ye, Liping Ye, Nonghua Lv, Shengsheng Zhang, Chengxia Liu, Mingquan Li, Qi Liu, Rongzhou Li, Jie Pan, Xiaocui Yang, Xuqing Zhu, Yumei Li, Bo Lao, Ansheng Ling, Honghui Chen, Xiuling Li, Ping Xu, Jianfeng Zhou, Baozhen Liu, Zhiqiang Du, Yiqi Du, Zhaoshen Li, Gastrointestinal Early Cancer Prevention & Treatment Alliance of China (GECA)

Abstract

Objective: To develop a gastric cancer (GC) risk prediction rule as an initial prescreening tool to identify individuals with a high risk prior to gastroscopy.

Design: This 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.

Results: The 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).

Conclusions: The 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.

Keywords: Helicobacter pylori; gastric cancer; gastrin-17; pepsinogen; prescreening; risk stratification.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow chart showing the proposed algorithm for the clinical pathways for the respective individuals. The cut-off values for each factor are shown in tables 2 and 4. G-17, gastrin-17; GC, gastric cancer; PG, pepsinogen.

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