A Preliminary Study On The Establishment Of Screening System For Early Gastric Cancer In The Wannan Region

Objective: The aim of this study was to detect pepsinogen I(PGI),pepsinogen II(PGII),pepsinogen ratio(PGR)and gastrin-17(G-17)expression levels in different gastric mucosal lesions,to explore the correlation between gastric function and gastric cancer(GC),and to evaluate the screening value of New Gastric Cancer Screening Scoring Scale for patients with GC.In addition,to analyze the risk factors for GC and precancerous lesions and to establish a feasible screening system for early gastric cancer(EGC)in the Wannan Region.Methods: Serum PGI,PGⅡ,PGR,G-17 and Helicobacter pylori(Hp)were tested simultaneously.Risk stratification of GC was carried out in accordance with New Gastric Cancer Screening Scoring Scale.Moderate-risk and high-risk groups of GC were enrolled in the Physical Examination Center and Gastrointestinal Outpatient of the Yijishan Hospital affiliated to Wannan Medical College between January 2019 and December 2020.The questionnaire survey,gastroscopy and pathologic biopsy were recommended for moderate-risk and high-risk groups.On the basis of gastroscopy and pathologic biopsy,patients were separated into five groups: non-atrophic gastritis group,precancerous diseases group,precancerous lesions group,EGC group and advanced GC group.The levels of PGI,PGII,PGR,G-17 and Hp were compared among each group.ROC curve was constructed to explore the value of serum PGI,PGII,PGR and G-17 and their combined diagnosis for GC.The detection rate of GC were compared among low-risk,moderate-risk and high-risk groups to evaluate the screening value of New Gastric Cancer Screening Scoring Scale.Independent risk indicators for GC and precancerous lesions were acquired by univariate and multivariate Logistic regression analysis.Results: A total of 16694 eligible participants were adopted in the screening.According to New Gastric Cancer Screening Scoring Scale,5948 cases of moderate-risk and high-risk individuals were enrolled,of which 851(14.31%)received the questionnaire survey,gastroscopy and pathologic biopsy,including 535 cases of non-atrophic gastritis,202 cases of precancerous diseases,84 cases of precancerous lesions,10 cases of EGC,14 cases of advanced GC,3 cases of gastric stromal tumor and 3 cases of esophageal carcinoma.A total of 24 cases of GC were screened,of which 41.67% were EGC.The detection rate of GC was 2.82%.The detection rate of GC in the low-risk,middle-risk and high-risk groups was 0%,1.95%,10.84%,respectively(P < 0.05).The levels of PGI and PGR in advanced GC group were significantly lower than those in non-atrophic gastritis group(P < 0.05),which was similar to EGC group.The levels of PGII and G-17 in advanced GC group were higher than those in non-atrophic gastritis group(P < 0.05),while there was no significant difference between EGC group and non-atrophic gastritis group(P > 0.05).The positive rate of Hp increased as the pathological diagnosis class increasing(P < 0.05).The results of ROC curve showed that the AUC of PGI,PGII,PGR and G-17 were 0.814(95%CI: 0.738-0.890),0.658(95%CI: 0.571-0.745),0.876(95%CI: 0.827-0.926),0.650(95%CI: 0.557-0.742),respectively.The AUC of combined detection of these four indices in the diagnosis of GC was 0.893(95% CI: 0.848-0.939),with the sensitivity was 91.7% and the specificity was 77.6%.Gender,age at diagnosis,Body Mass Index(BMI),Hp,smoking history,high-salt diet and fried food were independent risk factors,while green vegetables was an independent protective factor for GC and precancerous lesions(P < 0.05).Conclusion: 1.On the basis of New Gastric Cancer Screening Scoring Scale,the gastroscopy and pathologic biopsy are recommended for the asymptomatic moderate-risk and high-risk individuals with a score of more than 11 points,which is a feasible approach for mass screening of GC in the Wannan region.2.A total of 16694 eligible participants were adopted in the screening.5948 cases of moderate-risk and high-risk individuals were enrolled,of which 851(14.31%)received gastroscopy and pathologic biopsy.A total of 24 cases of GC were screened,of which41.67% were EGC.The detection rate of GC was 2.82%.It is essential for asymptomatic individuals of male patients aged from 50 to 59 years old with Hp infection to screen of EGC in the Wannan region.3.We should pay attention to various forms of health examination and education for GC to improve the number of patients who undergo gastroscopy in asymptomatic individuals.