| Gastric cancer is one of the most common gastrointestinal tumors.The occurrence of gastric cancer is closely related.with diet habits and lifestyle.Serum gastric function,including serum gastrin-17 and pepsinogen,also known as GastroPanel in Western countries,is commonly used for noninvasive gastric cancer screening,however the screening efficacy is controversial.Through a large scale,continuous national multi-center cross-sectional research,based on the hospital population,the risk factors of gastric cancer were investigated and analyzed;The relationship between serum gastric function and gastric cancer was analyzed,the cut-off value of serum gastric function index was established for gastric cancer screening;The risk prediction model and scoring system of gastric cancer based on gastric cancer risk factors and serum gastric function index were established,and the screening strategy of gastric cancer was explored.Part1.The investigation and analysis of gastric cancer epidemiologyObjective:To investigate the epidemiology of gastric cancer,to analyze the relationship between diet,lifestyle and metabolic syndrome and gastric cancer,and to provide the evidence for establishing the risk prediction model of gastric cancer.Methods:A cross-sectional research based on hospital population.The questionnaire was used to investigate the related factors such as diet,lifestyle and metabolic syndrome.All subjects were followed by questionnaire,blood test and gastroscopy.A total of 12961 patients were enrolled in the study,including 12637 cases of non-gastric cancer and 324 cases of gastric cancer.Logistic regression and chi-square test were used to analyze statistical data.Results:1.Case characteristics12961 cases were enrolled in the study,including 12637 cases of non-gastric cancer and 324 cases of gastric cancer.Non-gastric cancer group included 441 cases of non-atrophic gastritis,2950 cases of atrophic gastritis(282 cases of low grade intraepithelial neoplasia)and 4286 cases of other diagnoses(including peptic ulcer,reflux esophagitis and gastric polyps).Gastric cancer group included 127 cases(39.20%)of early gastric cancer and 197 cases(60.80%)of advanced gastric cancer.The average age was 57.29 ± 9.628.Female and male cases were 6545(50.5%)and 6416(49.5%),respectively.Symptomatic and asymptomatic patients were 10571(81.6%)and 2390(18.4%),respectively.2.Single variate analysis of the related factors of gastric cancerThe results shows that,old age,smoking,drinking,regular intake of overnight dishes,heavy taste,regular intake of marinated fried food and body mass index are high risk factors for gastric cancer,regular intake of fresh fruits and vegetables are the protective factors for gastric cancer.The detection rate of gastric cancer was higher from the female population with Diabetes and Hypertriglyceridemia,but the difference was not statistically significant,so the correlation between metabolic syndrome and gastric cancer was no significant.The risk of gastric cancer increased with age.Compared with group of aged 40-49,the risk of gastric cancer was gradually increased in group of aged 50-59,60-69 and older than 69,the OR values were 2.625(95% CI: 1.677-4.107),3.956(95% CI: 2.558-6.116)and 8.759(95% CI: 5.627-13.635).Drinking habit was a high risk factor for gastric cancer,and the risk increased with the alcohol consumption and drinking years.Compared with non-drinkers,the risk of gastric cancer was significantly higher in the drinking group of 550-2000 g/week and greater than 2000 g/week,the OR values were 2.617(95% CI: 1.599-4.281)and 2.408(95% CI: 1.524-3.804)respectively.Compared with non-drinkers,the risk of gastric cancer was significantly higher in the drinking group of more than 20 years,more than 30 years and more than 40 years,the OR values were 2.004(95% CI: 1.316-3.051),2.669 95% CI: 1.561-4.565)and 6.126(95% CI: 3.012-12.457).3.Multivariate analysis of the related factors of gastric cancerResults of multivariate logistic regression analysis shows that,gender,age,body mass index,salty dietary habit,fried food intake,and pickled food intake are risk factors for gastric cancer,however,fresh fruit intake is the protective factor.The logistic regression model for gastric cancer has good fit degree and distinction,the area under ROC curve was 0.737(95% CI: 0.708-0.766)(P <0.001).Conclusions:In this study,the relationship between diet habits and lifestyles and gastric cancer were analyzed comprehensively by large-scale epidemiological investigation,and the correlation between metabolic syndrome and gastric cancer was discussed.Results of multivariate logistic regression analysis shows that men,elderly,thinness,salty dietary habit,regular intake of pickled food,regular intake of fried food are risk factors for gastric cancer,regular intake of fresh fruit is a protective factor.Part2.Analysis of correlation between serum gastric function and gastric cancer,and analysis screening efficacy of serum gastric function for gastric cancerObjective:To investigate the correlation between serum gastric function and gastric cancer,to determine the cut-off value of serum gastric function for gastric cancer screening,and to evaluate the efficacy of serum gastric function in gastric cancer screening.Methods:A cross-sectional study based on hospital population.Fasting serum gastric function(including serum gastrin-17,pepsinogen? and pepsinogen?)was analyzed by enzyme-linked immunosorbent assay(ELISA),and then all subjects accepted endoscopy and biopsy.Regarding endoscopy and pathology diagnosis as gold standard,there are 2761 cases of non-atrophic gastritis,2950 cases of atrophic gastritis(282 cases of low grade intraepithelial neoplasia),127 cases of early gastric cancer,197 cases of advanced gastric cancer and Other diagnoses of 4286 cases.Using nonparametric tests,chi-square test,ROC curve area analysis and logistic regression analysis and other statistical methods.Results:1.Correlation between serum gastric function and gastric cancerCompared with non-gastric cancer group,the serum gastrin-17 and pepsinogen? levels were higher,and PGR was lower in gastric cancer group.Compared with non-atrophic gastritis group,serum pepsinogen? and PGR levels were lower in gastric cancer group.2.Screening efficacy of serum gastric function for gastric cancerSerum gastrin-17,pepsinogen? and PGR were reliable serum markers of screening gastric cancer,with the area under the ROC curve of 0.621(95% CI: 0.593-0.649),0.622(95% CI: 0.592-0.652)and 0.643(95% CI: 0.611-0.675)(P <0.001),the optimal cut-off value were 3.61pmol/L,12.00ug/L and 9.42,respectively.Regarding diagnosis using single index,the sensitivity of serum gastrin-17 was the highest(70.1%),while the specificity of PGR was the highest(65.3%).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of serum gastrin-17 were 70.1%(227/324),51.4%(6499/12637),3.6%(227/6365),98.5%(6499/6596)and 51.89%(6726/12961).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of serum pepsinogen? were 58.6%(190/324),62.5%(7892/12637),3.9%(190/4935),respectively,98.3%(7892/8026)and 63.96%(8082/12961).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of PGR were 58.3%(189/324),65.3%(8257/12637),4.1%(189/4569),98.4%(8257)/ 8392)and 64.65%(8446/12961).Regarding diagnosis using combined index,the diagnosis of serum gastrin-17 combined with PGR was better,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 44.1%(143/324),77.0%(9736/12637),4.7%(143/3044),98.2%(9736/9917)and 76.22%(9879/12961).When S-G-17 combined with PG?,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 43.5%(141/324),73.0%(9230/12637),4.0%(141/3548),98.1%(9230/9413)and 72.3%(9371/12961).3.Evaluation of predicting risk of gastric cancer using serum gastric functionThe gastric function ABC method combined with gastrin-17 and pepsinogen can predict the risk of gastric cancer and screen out the high risk population of gastric cancer.PGR <9.42 was regarded as PGR positive(+),PGR?9.42 was regarded as PGR negative(-);S-G-17> 3.61 pmol / L was regarded as G-17 positive(+),S-G-17?3.61 pmol / L as G-17 negative(-).According to the above criteria,all the subjects were divided into the following three groups: group A,group B and group C.Group A was negative for both S-G-17 and PGR,group B was positive for either S-G-17 or PGR,and group C was positive for both G-17 and PGR.The results showed that the detection rates of gastric cancer in group A,B and C were 1.0%(51/5071),2.7%(130/4846)and 4.7%(143/3044),respectively.The risk of gastric cancer in each group increased from group A to group C.Compared with group A,the risk of gastric cancer in group B and C was 2.532(95%: 1.823-3.515)and 4.392(95%: 3.171-6.084)(P <0.001),respectively.Conclusions:Through cross-sectional research of large sample and continuous cases based on hospital population,the best cut-off value of gastric cancer screening for gastric cancer were determined,and the serum gastric function ABC method was established to predict the risk of gastric cancer.The results of this study show that serum gastrin-17,pepsinogen? and PGR are the reliable serological indicators of screening gastric cancer,the diagnosis of serum gastrin-17 combined with PGR was best;serum gastric function ABC method can Screen out the high risk population of gastric cancer,group C had the greatest risk of gastric cancer.Part3.The establishment of risk prediction model and the scoring system for gastric cancer,based on the epidemiology of gastric cancer and serum gastric functionObjective:The risk prediction model and scoring system of gastric cancer were established based on the gastric cancer related factors and serum gastric function indexes,and the screening efficacy was evaluated.Methods:Regarding endoscopy and pathologic diagnosis as gold standard,12961 cases were enrolled in this study,including 12637 cases of non-gastric cancer group and 324 cases of gastric cancer group.Based on the epidemiology of gastric cancer and serum gastric function,multivariate logistic regression was analyzed,the risk prediction model and scoring system of gastric cancer were established.The area under the ROC curve was used to evaluate the screening efficacy of gastric cancer.Finally,the accuracy of the scoring system was verified by the other enrolled subjects.,including 893 cases of non-gastric cancer group and 25 cases of gastric cancer group.Results:1.The establishment of gastric cancer risk prediction model based on gender,age and serum gastric functionGender,age,S-G-17(?3.61pmol/L)and PGR(<9.42)were analyzed adopting logistic regression,and the diagnostic model of gastric cancer was established,which could improve the screening efficacy of serum gastric function on gastric cancer.The area under the ROC curve was 0.750(95% CI: 0.729-0.780),the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 82.4%(267/324),56.2%(7106 / 12637),4.6%(267/5798),99.2%(7106/7163)and 56.89%(7373/12961),respectively.2.The establishment of gastric cancer risk prediction model and scoring system based on gastric cancer-related factors and serum gastric functionThe factors such as sex,age,body mass index,dietary salty habit,pickled food intake,fried food intake,fruit intake,SG-17(?3.61 pmol / L)and PGR(<9.42)were analyzed adopting logistic regression,and the diagnostic model of gastric cancer was established,which could further improve the screening efficacy of serum gastric function.The area under the ROC curve was 0.777(95% CI: 0.751-0.802),the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 68.8%(223/324),73.6%(9303/12637),6.3%(223/3557),98.9%(9303/9404)and 73.50%(9526/12961),respectively.Assign scores based on OR values,the risk prediction scoring system was established.The system scoring ranged from 0 to 24,and the area under the ROC curve was 0.775(95% CI: 0.749-0.800).The subjects were divided into low risk group and high risk group.The detection rate of gastric cancer was 5.5%(234/4255)in the high risk group(11-24)and 1.0%(90/8706)in the low risk group(0-10),and the risk for gastric cancer in the high risk group was higher than in low risk group significantly.The cut-off value of the scoring system was 11 points,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 72.2%(234/324)?68.2%(8616/12637)?5.5%(234/4255)?99.0%(8616/8706)and 68.28%(7373/12961),respectively.918 cases were enrolled into the verified group,including 893 cases of non-gastric cancer and 25 cases of gastric cancer.According to the criteria of the score system,the total score ranged from 0 to 20,and the area under the ROC curve was 0.683(95% CI: 0.583-0.783).The detection rate of gastric cancer was 5.1% in the high risk group(11-20 points)and 1.6% in the low risk group(0-10 points),and the risk for gastric cancer in the high risk group was higher than in low risk group significantly.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the scoring system for the diagnosis of gastric cancer were 60.0%(15/25)?68.6%(613/893)?5.1%(15/295)?99.0%(613/623)and 68.4%(628/918),respectively.Conclusions:The risk of prediction model and scoring system for gastric cancer based on the epidemiology of gastric cancer and serum gastric function can predict the risk of gastric cancer in the hospital population,screen out the high risk population of gastric cancer,saving medical costs and improve the diagnosis of early gastric cancer. |
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