Gastric Cancer Screening And Related Risk Factors Analysis In The Wuwei Natural Population Cohort

OBJECTIVEBased on cross-sectional baseline data collected from the Wuwei natural population cohort,a cohort in the gastric cancer high-risk area Wuwei City of Gansu province in western China,including epidemiological investigation,gastroscopy screening and pathological diagnosis information cross-sectional baseline data,we will discuss the prevalence of gastric cancer and precancerous disease as well as the associated risk factors for gastric cancer in this high-risk area.We will also try to provide theoretical basis for establishing prevention and control system and policy in this high-risk area.METHODSA descriptive analysis of composition of the age,gender,occupation and other criteria was performed for the epidemiological survey data,gastroscopy and pathological diagnosis data obtained from the Wuwei cohort.Analysis of the cohort's screening results from gastroscopy and pathological diagnosis of gastric cancer,esophageal cancer and upper gastrointestinal disease was also performed.Through analyzing the relationship between diseases such as gastric cancer and precancerous lesions and data criteria such as H.pylori infection,demography,lifestyle,and related clinical examination data,gastric cancer and precancerous lesion associated risk factors were explored.The rate comparison was performed using chi-square test and Fisher exact probability method,and risk factor analysis was performed using single factor difference analysis and logistic regression model.RESULTS1.Wuwei cohort consists of a total of 24,115 people with the average age of50.77±7.77 years old and including 47.50%of male and 52.50%female.Han ethnicity accounts for 99.86%of the cohort.Farmer accounts for 93.68%,and majority of the cohort participant has an education of high school or less.2.Including gastric cancer and esophageal cancer,the number of upper gastrointestinal tract cancer diagnosis in this cohort is 351 cases,including 3 cases where stomach and esophagus cancer were both present.The total detection rate is1.59%;there were 110 cases of esophageal cancer,with a detection rate of 0.50%;there were 244 cases of gastric cancer,detection rate of 1.10%.the diagnostic rate of early gastric cancer is 72.50%?177 of 244 cases?,and the diagnosis rate of early esophageal cancer is 88.20%?97 of 110 cases?.3.Of the 22,114 gastroscopy screening diagnosis done in the cohort,there were15,680 cases of chronic atrophic gastritis?70.90%?,5,462 cases of chronic non-atrophic gastritis?24.69%?;there were 606 cases of gastric ulcers?2.74%?as well as 364 cases of duodenal bulb ulcers?1.64%?,and the ratio between the two is 1.66;we also found polyps in 1,848 cases?8.35%?.Among 11,155 participants with pathologic diagnosis,there were 1,694 cases of chronic atrophic gastritis?15.18%?,and 7,577 cases of precancerous lesions?67.92%?.Within the precancerous lesion cases,there were 3,202cases of chronic atrophic gastritis?28.70%?,1,990 cases of intestinal metaplasia?17.83%?,and low level intraepithelial neoplasia in 2,385 cases?21.38%?.4.22,060 people used ¹⁴C breath test to detect helicobacter pylori?H.pylori?,and the H.pylori infection rate was 53.04%.Among the gastroduodenal diseases,gastric cancer,chronic non-atrophic gastritis,chronic atrophic gastritis,peptic ulcers,polyps's respective H.pylori infection rates were 49.87%,46.59%,55.41%,66.90%,54.27%.Among the 11,155 cases with pathological diagnosis of gastric cancer,chronic atrophic gastritis,chronic atrophic gastritis and intestinal metaplasia,low level intraepithelial neoplasia,their respective H.pylori infection rates were 47.74%,45.46%,54.17%,56.50%,58.48%.The H.pylori infection rate rises as the pathological diagnosis class increases from chronic atrophic gastritis to the low level of intraepithelial neoplasia?P<0.05?.5.The related risk factors analysis showed that gender,age,family income,BMI,dyspepsia and peptic ulcer syndrome are independent risk factors of gastric cancer;gender,age,education level,occupation,number in household,smoking,exercise,ingesting hot food,H.pylori infection,hypertension,history of peptic ulcer and indigestion syndrome are independent risk factors of precancerous lesion.CONCLUSION1.Wuwei cohort has a high incidence rate of chronic atrophic gastritis and gastric ulcers,and this phenomenon could possibly suggest that high incidence of precancerous disease is the basis for the high incidence of gastric cancer in the same region.2.The observation of H.pylori infection rate increasing with the rising of pathological level from chronic non-atrophic gastritis to low level intraepithelial neoplasia suggests that H.pylori infection plays an important role in the progress of gastric cancer.3.Gender,age,family income,BMI,dyspepsia syndrome and peptic ulcer syndrome may be independent risk factors of gastric cancer;gender,age,education level,occupation,number in household,smoking,exercise,ingesting hot food,H.pylori infection,hypertension,history of peptic ulcer and indigestion syndrome may be independent risk factors of precancerous lesions.4.Using gastroscopy screening,Wuwei cohort's early gastric cancer diagnostic rate was 72.50%.This shows that gastroscopy screening is an effective tool to find gastric cancer or to improve the early diagnostic rate of gastric cancer in high-risk regions.