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
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...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。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。
