Objective:This study aimed to develop and validate a risk scoring system to identify high-risk individuals carrying malignant lesions in stomach for tailored gastric cancer screening.Methods:A gastric cancer risk scor...Objective:This study aimed to develop and validate a risk scoring system to identify high-risk individuals carrying malignant lesions in stomach for tailored gastric cancer screening.Methods:A gastric cancer risk scoring system(GC-RSS)was developed based on questionnaire-based predictors for gastric cancer derived from systematic literature review.To assess the capability of this system for discrimination,risk scores for 8,214 and 7,235 outpatient subjects accepting endoscopic examination in two endoscopy centers,and 32,630 participants in a community-based cohort in China were calculated to plot receiver operating characteristic curves and generate area under the curve(AUC).To evaluate the performance of GC-RSS,the screening proportion,sensitivity and detection rate ratio compared to universal screening were used under different risk score cutoff values.Results:GC-RSS comprised nine predictors including advanced age,male gender,low body mass index(<18.5 kg/m^(2)),family history of gastric cancer,cigarette smoking,consumption of alcohol,preference for salty food,irregularity of meals and consumption of preserved food.This tool performed well in determining the risk of malignant gastric lesions with AUCs of 0.763,0.706 and 0.696 in three validation sets.When subjects with risk scores≥5 were evaluated with endoscopy,nearly 50%of these endoscopies could be saved with a detection rate of over 1.5 times achieved.When the cutoff was set at 8,only about 10%of subjects with the highest risk would be offered endoscopy,and detection rates for gastric cancer could be increased 2-4 fold compared to universal screening.Conclusions:An effective questionnaire-based GC-RSS was developed and validated.This tool may play an important role in establishing a tailored screening strategy for gastric cancer in China.展开更多
Objective:Contemporary prostate cancer(PCa)screening modalities such as prostate specific antigen(PSA)and digital rectal examination(DRE)are limited in their ability to predict the detection of clinically significant ...Objective:Contemporary prostate cancer(PCa)screening modalities such as prostate specific antigen(PSA)and digital rectal examination(DRE)are limited in their ability to predict the detection of clinically significant disease.Multi-parametric magnetic resonance imaging(mpMRI)of the prostate has been explored as a staging modality for PCa.Less is known regarding its utility as a primary screening modality.We examined our experience with mpMRI as both a screening and staging instrument.Methods:mpMRI studies performed between 2012 and 2014 in patients without PCa were cross-referenced with transrectal ultrasonography(TRUS)biopsy findings.Statistical analyses were performed to determine association of mpMRI findings with overall cancer diagnoses and clinically significant(Gleason score≥7)disease.Subgroup analyses were then performed on patients with a history of prior negative biopsy and those without a history of TRUS biopsy.mpMRI studies were also cross-referenced with RP specimens.Statistical analyses determined predictive ability of extracapsular extension(ECE),seminal vesicle involvement(SVI),and pathologic evidence of clinically significant disease(Gleason score7).Results:Four hundred biopsy naive or prior negative biopsy patients had positive mpMRI studies.Overall sensitivity,specificity,positive and negative predictive values were 94%,37%,58%,and 87%,respectively and 95%,31%,42%,and 93%,respectively for overall cancer detection and Gleason score≥7 disease.In patients with no prior biopsy history,mpMRI sensitivity,specificity,positive and negative predictive values were 94%,36%,65%,and 82%,for all cancers,and 95%,30%,50%,and 89%for Gleason score7 lesions,respectively.In those with prior negative biopsy sensitivity,specificity,positive and negative predictive values were 94%,37%,52%,and 90% for all cancers,and 96%,32%,36%,and 96% for Gleason score7 lesions,respectively.Seventy-four patients underwent radical prostatectomy(RP)after mpMRI.Lesion size on mpMRI correlated with the presence of Gleason score7 cancers(p Z 0.005).mpMRI sensitivity,specificity,positive and negative predictive values were 84%,39%,81%,and 44% respectively,for Gleason7 cancer.For ECE and SVI,sensitivity and specificity were 58% and 98% and 44% and 97%,respectively.Conclusion:mpMRI is an accurate predictor of TRUS biopsy and RP outcomes.mpMRI has significant potential to change PCa management,particularly in the screening population,in whom a significant proportion may avoid TRUS biopsy.Further studies are necessary to determine how mpMRI should be incorporated into the current PCa screening and staging paradigms.展开更多
目的评估新型胃癌筛查评分系统在胃癌筛查及癌前病变风险评估中的价值。方法纳入2018年3月—2019年9月因胃部不适在嘉兴市第一医院行胃镜检查的患者共442例。内镜检查前患者根据新型胃癌筛查评分系统分为3组:低危组(0~11分)、中危组(12...目的评估新型胃癌筛查评分系统在胃癌筛查及癌前病变风险评估中的价值。方法纳入2018年3月—2019年9月因胃部不适在嘉兴市第一医院行胃镜检查的患者共442例。内镜检查前患者根据新型胃癌筛查评分系统分为3组:低危组(0~11分)、中危组(12~16分)和高危组(17~23分),分析3组胃癌及萎缩性胃炎检出情况。根据胃黏膜萎缩及肠化的范围和程度,按照慢性胃炎分级评估系统(operative link for gastritis assessment,OLGA)及慢性胃炎肠化分级评估系统(operative link for gastritis intestinal metaplasia,OLGIM)将患者分为相应的0~Ⅳ级5组,比较新型胃癌筛查评分系统与OLGA、OLGIM系统在癌前病变风险评估中的联系。结果442例患者根据新型胃癌筛查评分系统分组,低危组211例,中危组207例,高危组24例;按OLGA分组,0级241例,Ⅰ级105例,Ⅱ级58例,Ⅲ级27例,Ⅳ级11例;按OLGIM分组,0级224例,Ⅰ级113例,Ⅱ级61例,Ⅲ级31例,Ⅳ级13例。胃蛋白酶原Ⅰ水平(F=2.844,P=0.027)和胃蛋白酶原比值(F=5.435,P=0.001)在OLGA分级标准下5组间比较差异有统计学意义,其中Ⅲ级和Ⅳ级组明显低于其他3组(P均<0.001)。胃蛋白酶原比值在OLGIM分级标准下5组间比较差异有统计学意义(F=3.887,P=0.008),其中Ⅳ级组明显低于其他各组(P均<0.001)。Gamma系数检验及Kendall′s tau-b检验显示OLGA、OLGIM系统与新型胃癌筛查评分系统之间存在较强的一致性(P<0.001)。结论新型胃癌筛查评分系统有助于胃癌筛查,同时与OLGA、OLGIM在胃癌前病变风险评估方面存在密切联系,可应用于我国胃癌前病变风险评估。展开更多
基金supported by the National Science&Technology Fundamental Resources Investigation Program of China(No.2019FY101102)the National Natural Science Foundation of China(No.82073626,81773501)+5 种基金the National Key R&D Program of China(No.2016YFC0901404)the Beijing-Tianjin-Hebei Basic Research Cooperation Project(No.J200016)the Digestive Medical Coordinated Development Center of Beijing Hospitals Authority(No.XXZ0204)the Beijing Hospitals Authority Youth Programme(No.QML20201101)Sanming Project of Shenzhen(No.SZSM201612061)the Beijing Nova Program(No.Z201100006820093)。
文摘Objective:This study aimed to develop and validate a risk scoring system to identify high-risk individuals carrying malignant lesions in stomach for tailored gastric cancer screening.Methods:A gastric cancer risk scoring system(GC-RSS)was developed based on questionnaire-based predictors for gastric cancer derived from systematic literature review.To assess the capability of this system for discrimination,risk scores for 8,214 and 7,235 outpatient subjects accepting endoscopic examination in two endoscopy centers,and 32,630 participants in a community-based cohort in China were calculated to plot receiver operating characteristic curves and generate area under the curve(AUC).To evaluate the performance of GC-RSS,the screening proportion,sensitivity and detection rate ratio compared to universal screening were used under different risk score cutoff values.Results:GC-RSS comprised nine predictors including advanced age,male gender,low body mass index(<18.5 kg/m^(2)),family history of gastric cancer,cigarette smoking,consumption of alcohol,preference for salty food,irregularity of meals and consumption of preserved food.This tool performed well in determining the risk of malignant gastric lesions with AUCs of 0.763,0.706 and 0.696 in three validation sets.When subjects with risk scores≥5 were evaluated with endoscopy,nearly 50%of these endoscopies could be saved with a detection rate of over 1.5 times achieved.When the cutoff was set at 8,only about 10%of subjects with the highest risk would be offered endoscopy,and detection rates for gastric cancer could be increased 2-4 fold compared to universal screening.Conclusions:An effective questionnaire-based GC-RSS was developed and validated.This tool may play an important role in establishing a tailored screening strategy for gastric cancer in China.
文摘Objective:Contemporary prostate cancer(PCa)screening modalities such as prostate specific antigen(PSA)and digital rectal examination(DRE)are limited in their ability to predict the detection of clinically significant disease.Multi-parametric magnetic resonance imaging(mpMRI)of the prostate has been explored as a staging modality for PCa.Less is known regarding its utility as a primary screening modality.We examined our experience with mpMRI as both a screening and staging instrument.Methods:mpMRI studies performed between 2012 and 2014 in patients without PCa were cross-referenced with transrectal ultrasonography(TRUS)biopsy findings.Statistical analyses were performed to determine association of mpMRI findings with overall cancer diagnoses and clinically significant(Gleason score≥7)disease.Subgroup analyses were then performed on patients with a history of prior negative biopsy and those without a history of TRUS biopsy.mpMRI studies were also cross-referenced with RP specimens.Statistical analyses determined predictive ability of extracapsular extension(ECE),seminal vesicle involvement(SVI),and pathologic evidence of clinically significant disease(Gleason score7).Results:Four hundred biopsy naive or prior negative biopsy patients had positive mpMRI studies.Overall sensitivity,specificity,positive and negative predictive values were 94%,37%,58%,and 87%,respectively and 95%,31%,42%,and 93%,respectively for overall cancer detection and Gleason score≥7 disease.In patients with no prior biopsy history,mpMRI sensitivity,specificity,positive and negative predictive values were 94%,36%,65%,and 82%,for all cancers,and 95%,30%,50%,and 89%for Gleason score7 lesions,respectively.In those with prior negative biopsy sensitivity,specificity,positive and negative predictive values were 94%,37%,52%,and 90% for all cancers,and 96%,32%,36%,and 96% for Gleason score7 lesions,respectively.Seventy-four patients underwent radical prostatectomy(RP)after mpMRI.Lesion size on mpMRI correlated with the presence of Gleason score7 cancers(p Z 0.005).mpMRI sensitivity,specificity,positive and negative predictive values were 84%,39%,81%,and 44% respectively,for Gleason7 cancer.For ECE and SVI,sensitivity and specificity were 58% and 98% and 44% and 97%,respectively.Conclusion:mpMRI is an accurate predictor of TRUS biopsy and RP outcomes.mpMRI has significant potential to change PCa management,particularly in the screening population,in whom a significant proportion may avoid TRUS biopsy.Further studies are necessary to determine how mpMRI should be incorporated into the current PCa screening and staging paradigms.
文摘目的评估新型胃癌筛查评分系统在胃癌筛查及癌前病变风险评估中的价值。方法纳入2018年3月—2019年9月因胃部不适在嘉兴市第一医院行胃镜检查的患者共442例。内镜检查前患者根据新型胃癌筛查评分系统分为3组:低危组(0~11分)、中危组(12~16分)和高危组(17~23分),分析3组胃癌及萎缩性胃炎检出情况。根据胃黏膜萎缩及肠化的范围和程度,按照慢性胃炎分级评估系统(operative link for gastritis assessment,OLGA)及慢性胃炎肠化分级评估系统(operative link for gastritis intestinal metaplasia,OLGIM)将患者分为相应的0~Ⅳ级5组,比较新型胃癌筛查评分系统与OLGA、OLGIM系统在癌前病变风险评估中的联系。结果442例患者根据新型胃癌筛查评分系统分组,低危组211例,中危组207例,高危组24例;按OLGA分组,0级241例,Ⅰ级105例,Ⅱ级58例,Ⅲ级27例,Ⅳ级11例;按OLGIM分组,0级224例,Ⅰ级113例,Ⅱ级61例,Ⅲ级31例,Ⅳ级13例。胃蛋白酶原Ⅰ水平(F=2.844,P=0.027)和胃蛋白酶原比值(F=5.435,P=0.001)在OLGA分级标准下5组间比较差异有统计学意义,其中Ⅲ级和Ⅳ级组明显低于其他3组(P均<0.001)。胃蛋白酶原比值在OLGIM分级标准下5组间比较差异有统计学意义(F=3.887,P=0.008),其中Ⅳ级组明显低于其他各组(P均<0.001)。Gamma系数检验及Kendall′s tau-b检验显示OLGA、OLGIM系统与新型胃癌筛查评分系统之间存在较强的一致性(P<0.001)。结论新型胃癌筛查评分系统有助于胃癌筛查,同时与OLGA、OLGIM在胃癌前病变风险评估方面存在密切联系,可应用于我国胃癌前病变风险评估。