不同胃癌筛查方案在早期胃癌诊断中的应用价值

The value of different risk stratifications in the diagnosis of early gastric cancer

目的比较《中国早期胃癌筛查流程专家共识意见(2017年,上海)》中提出的流行病学调查、新型胃癌筛查评分系统和《京都胃炎分类》提出的胃癌风险内镜评分三种筛查方案的检验效能,验证不同方案对早期胃癌患者风险评估的准确性。方法纳入行早期胃癌内镜黏膜下剥离术并经病理证实的患者为胃癌组,连续纳入同期非胃癌患者为对照组,入组患者行问卷调查及血清学检测,胃镜检查过程中按照京都胃炎分类记录内镜下表现。评估不同筛查方案各危险分层胃癌患者比例,绘制不同方案单独诊断及联合诊断胃癌的受试者工作曲线(ROC),使用ROC曲线下面积评估不同方案检验效能。结果共纳入研究对象204例,其中胃癌患者84例,非胃癌120例,三种筛查方案中,京都胃癌风险内镜评分诊断价值最高(AUC=0.79),其灵敏度和特异度分别为72.6%和79.1%,不同方案联合诊断未明显提高早期胃癌检验效能;在新型胃癌评分系统划定的中高危人群中,京都胃癌风险内镜评分更有鉴别价值。结论京都胃癌风险内镜评分在早期胃癌诊断中有较高临床价值,可与新型胃癌筛查评分系统联合用于早期胃癌风险评估。

Objective To compare the diagnostic efficacy of three screening methods,including the epidemiological survey and the new gastric cancer scoring system proposed in the Expert Consensus Opinion on Early Gastric Cancer Screening Process in China(Shanghai,2017),and the Kyoto classification score for screening gastric in early gastric cancer diagnosis.Methods Patients who underwent endoscopic submucosal dissection and were pathologically confirmed were included in the gastric cancer group,patients with non-gastric cancer in the same period were consecutively included in the control group.Questionnaires and serological tests were performed in all enrolled patients,and the endoscopic presentations was recorded according to the classification of Kyoto gastritis during gastroscopy.The risk stratification and the detection rates of gastric cancer were estimated by different screening methods,and the receiver operating characteristic curve(ROC curve)of subjects diagnosed with each screening method alone and in combination were plotted to compare the area under the ROC curve(AUC)and the diagnostic efficacy.Results Among all participants,84 were patients with gastric cancer and 120 were normal people without gastric cancer.The Kyoto risk score had the highest diagnostic value(AUC=0.79)among the others,and its sensitivity and specificity were 72.6%and 79.1%,respectively,but the combined diagnosis of different methods did not significantly improve the diagnostic efficacy.The Kyoto risk score had a more discriminative value in the medium to high-risk group delineated by the new scoring system.Conclusion The Kyoto risk score has high clinical value in the diagnosis of early gastric cancer and can be used in conjunction with the new scoring system for early gastric cancer risk assessment.