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Original article
Development and validation of a prediction rule for estimating gastric cancer risk in the Chinese high-risk population: a nationwide multicentre study
  1. Quancai Cai1,
  2. Chunping Zhu1,
  3. Yuan Yuan2,
  4. Qi Feng3,
  5. Yichao Feng4,
  6. Yingxia Hao5,
  7. Jichang Li6,
  8. Kaiguang Zhang7,
  9. Guoliang Ye8,
  10. Liping Ye9,
  11. Nonghua Lv10,
  12. Shengsheng Zhang11,
  13. Chengxia Liu12,
  14. Mingquan Li13,
  15. Qi Liu14,
  16. Rongzhou Li15,
  17. Jie Pan16,
  18. Xiaocui Yang17,
  19. Xuqing Zhu18,
  20. Yumei Li19,
  21. Bo Lao20,
  22. Ansheng Ling21,
  23. Honghui Chen22,
  24. Xiuling Li23,
  25. Ping Xu24,
  26. Jianfeng Zhou25,
  27. Baozhen Liu26,
  28. Zhiqiang Du27,
  29. Yiqi Du1,
  30. Zhaoshen Li1
  31. Gastrointestinal Early Cancer Prevention & Treatment Alliance of China (GECA)
  1. 1 Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
  2. 2 Tumor Etiology and Screening Department, China Medical University, Shenyang, China
  3. 3 Department of Gastroenterology, Mianyang Central Hospital, Mianyang, China
  4. 4 Department of Gastroenterology, Affiliated Hospital of Yan’an University, Yanan, China
  5. 5 Department of Gastroenterology, Baoding First Central Hospital, Baoding, China
  6. 6 Department of Gastroenterology, Baoji Central Hospital, Baoji, China
  7. 7 Department of Gastroenterology, Anhui Provincial Hospital, Hefei, China
  8. 8 Department of Gastroenterology, Affiliated Hospital of Ningbo University, Ningbo, China
  9. 9 Department of Gastroenterology, Taizhou Hospital, Taizhou, China
  10. 10 Department of Gastroenterology, First Affiliated Hospital of Nanchang University, NanChang, China
  11. 11 Department of Gastroenterology, Beijing Traditional Chinese Medicine Hospital of Capital Medical University, Beijing, China
  12. 12 Department of Gastroenterology, Affiliated Hospital of Binzhou Medical College, Binzhou, China
  13. 13 Department of Gastroenterology, Yan’an People’s Hospital, Yan’an, China
  14. 14 Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
  15. 15 Department of Gastroenterology, Ruian People’s Hospital, Rui’an, China
  16. 16 Department of Gastroenterology, Wenzhou Central Hospital, Wenzhou, China
  17. 17 Department of Gastroenterology, Ankang Central Hospital, Ankang, China
  18. 18 Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou, China
  19. 19 Department of Gastroenterology, Zhejiang General Team Hospital of Chinese People’s Armed Police Force, Hangzhou, China
  20. 20 Department of Gastroenterology, Ningbo Yinzhou District Second Hospital, Ningbo, China
  21. 21 Department of Gastroenterology, Anqing First People’s Hospital, Anqing, China
  22. 22 Department of Gastroenterology, Second Affiliated Hospital of South China University, Hengyang, China
  23. 23 Department of Gastroenterology, Henan Provincial People’s Hospital, Zhengzhou, China
  24. 24 Department of Gastroenterology, Shanghai Songjiang Distict Central Hospital, Shanghai, China
  25. 25 Department of Gastroenterology, Ningbo Beilun District Xiaogang Hospital, Ningbo, China
  26. 26 Department of Gastroenterology, Binzhou People’s Hospital, Binzhou, China
  27. 27 Department of Gastroenterology, Jianyang People’s Hospital, Jianyang, China
  1. Correspondence to Prof Yiqi Du and Prof Zhaoshen Li, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; duyiqi{at}, zhsl{at}


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.

  • gastric cancer
  • prescreening
  • risk stratification
  • pepsinogen
  • gastrin-17
  • Helicobacter pylori

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  • QC, CZ and YY contributed equally.

  • Contributors Conception and design: Q-C, YY, YD and ZL; financial support: YD and ZL; administrative support: Q-C and CZ; provision of study materials or patients: QF, YF, YH, JL, KZ, GY, LY, NL, SZ, CL, ML, QL, RL, JP, XY, XZ, YL, BL, AL, HC, XL, PX, JZ, BL and ZD; collection and assembly of data: Q-CC, CZ, QF, YF, YH, JL, KZ, GY, LY, NL, SZ, CL, ML, QL, RL, JP, XY, XZ, YL, BL, AL, HC, XL, PX, JZ, BL and ZD.

  • Funding This work was supported by the National Science and Technology Plan Project of the Ministry of Science and Technology of China (Grant No. 2015BAI13B08).

  • Competing interests None declared.

  • Ethics approval The study protocol was approved by the ethics committees of the respective institutions (the leading approval as CHEC2014-066 by Changhai Hospital).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it published Online First. The acknowledgements section has been updated.

  • Patient consent for publication Not required.

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