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
- risk stratification
- 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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