李氏新型胃癌筛查评分联合中性粒细胞与淋巴细胞比值对重庆市两江新区胃癌筛查的意义探索

The significance of Lee’s new gastric cancer screening score combined with neutrophil-to-lymphocyte ratio in gastric cancer screening in Chongqing Liangjiang new area

目的分析李氏新型胃癌筛查评分联合中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)对重庆市两江新区胃癌筛查的意义。方法选取2017年8月至2022年6月在重庆两江新区第一人民医院进行胃癌筛查的1683例人群为研究对象,根据胃镜结果分类为胃癌、癌前状态与非萎缩性胃炎,比较不同胃镜报告研究对象的李氏新型胃癌筛查评分与NLR,采用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)的曲线下面积(area under the curve,AUC)评价其对胃癌的预测价值。结果根据李氏新型胃癌筛查评分结果,全部1683例研究对象共有1066例(63.3%)属于胃癌低风险(0~11分),525例(31.2%)属于胃癌中风险(12~16分),92例(5.5%)属于胃癌高风险(17~23分)。全部研究对象均进一步行胃镜检查,共发现50例(3.0%)胃癌,845例(50.2%)癌前状态,788例(46.8%)非萎缩性胃炎,秩和检验结果表明胃癌的检出率随着风险等级的增加逐步升高,二者之间存在明显相关性(Z=123.726,P<0.001)。胃癌患者的李氏新型胃癌筛查评分、NLR均显著高于癌前状态患者和非萎缩性胃炎患者(均P<0.05),癌前状态患者的李氏新型胃癌筛查评分、NLR显著均高于非萎缩性胃炎患者(均P<0.05)。ROC曲线结果表明,李氏新型胃癌筛查评分和NLR对胃癌均具有一定的预测价值(AUC>0.7),其中李氏新型胃癌筛查评分的AUC更高,且李氏新型胃癌筛查评分联合NLR能进一步提高预测价值(AUC>0.8)。结论李氏新型胃癌筛查评分与NLR对重庆市两江新区的胃癌筛查具有重要的临床意义,二者联合后能提高对胃癌的预测价值。

Objective To analyze the significance of Lee’s new gastric cancer screening score combined with neutrophil-tolymphocyte(NLR)ratio in gastric cancer screening in Chongqing Liangjiang new area.Method One thousand six hundred and eighty-three research subjects received gastric cancer screening in the First People’s Hospital of Chongqing Liangjiang New Area from August 2017 to June 2022 were enrolled for the research.According to the results of gastroscopy,they were divided into gastric cancer,precancerous state and non-atrophic gastritis.The Lee’s new gastric cancer screening scores and NLR were compared among research subjects with different gastroscopes report,and their predictive value for gastric cancer was evaluated by area under the curve(AUC)of receiver operator characteristic curve(ROC).Result According to Lee’s new gastric cancer screening score,a total of 1066 cases(63.3%)of all 1683 subjects were low-risk(0 to 11 points),525 cases(31.2%)were medium-risk(12 to 16 points)and 92 cases(5.5%)were high-risk(17 to 23 points)for gastric cancer.All research subjects were further examined by gastroscopy,and the results showed that all 1683 research subjects found 50 cases(3.0%)of gastric cancer,845 cases(50.2%)of precancerous state,and 788 cases(46.8%)of non-atrophic gastritis.Rank sum test showed that the detection rate of gastric cancer gradually increased with the increase of risk level,and there was a significant correlation between them(Z=123.726,P<0.001).The Lee’s new gastric cancer screening score and NLR of gastric cancer patients were significantly higher than those of precancerous patients and nonatrophic gastritis patients,and the Lee’s new gastric cancer screening score and NLR of precancerous patients were significantly higher than those of non-atrophic gastritis patients(P<0.05).ROC curve showed that Lee’s new gastric cancer screening score and NLR had certain predictive value(AUC>0.7),of which Lee’s new gastric cancer screening score had a higher AUC,and Lee’s new gastric cancer screening score combined with NLR could further improve the predictive value(AUC>0.8).Conclusion Lee’s new gastric cancer screening score and NLR have important clinical significance for gastric cancer screening of this region,and their combination can improve the predictive value of gastric cancer.