Construction of the risk factor model of gastric cancer and its value in screening opportunity and options

苗长丰; 马云涛; 王晓鹏; 狐　鸣; 杨晓军

doi:10.19401/j.cnki.1007-3639.2019.07.004

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Construction of the risk factor model of gastric cancer and its value in screening opportunity and options

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- Construction of the risk factor model of gastric cancer and its value in screening opportunity and options
- China Oncology Vol. 29, Issue 7, Pages: 501-507(2019)
- 作者机构：
  
  1. 甘肃省人民医院普外科,甘肃,兰州,730030
  2. 甘肃省人民医院西院区普外科,甘肃,兰州,730000
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2019.07.004
  CLC： R735.2
- Published Online：12 July 2019，
  
  Published：12 July 2019
- 稿件说明：
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苗长丰,马云涛,王晓鹏,狐　鸣,杨晓军 . 胃癌高危因素评分模型构建及对筛查时机、方案选择的价值研究[J]. 中国癌症杂志, 2019, 29(7): 501-507.

苗长丰, 马云涛, 王晓鹏, et al. Construction of the risk factor model of gastric cancer and its value in screening opportunity and options[J]. China Oncology, 2019, 29(7): 501-507.
苗长丰,马云涛,王晓鹏,狐　鸣,杨晓军 . 胃癌高危因素评分模型构建及对筛查时机、方案选择的价值研究[J]. 中国癌症杂志, 2019, 29(7): 501-507. DOI： 10.19401/j.cnki.1007-3639.2019.07.004.

苗长丰, 马云涛, 王晓鹏, et al. Construction of the risk factor model of gastric cancer and its value in screening opportunity and options[J]. China Oncology, 2019, 29(7): 501-507. DOI： 10.19401/j.cnki.1007-3639.2019.07.004.

摘要

背景与目的：伺机性筛查也称为个体筛查，是一种基于临床表征的筛查方法，花费少，患者依从性高，是目前提高我国早期胃癌检出率的可行途径。基于患者基线资料及血液学检查等常用指标，构建一套关于胃癌高危因素评分模型，探讨其对胃癌高危患者筛查时机、方案选择的价值，以期为临床高效筛查提供更多依据。方法：收集2014年6月—2017年12月甘肃省人民医院普外科收治的387例胃黏膜相关疾病患者为研究对象。收集幽门螺杆菌（Helicobacter pylori，HP）感染情况、血清胃蛋白酶原（pepsinogen，PG）Ⅰ及PGⅠ/Ⅱ等指标，采用病例-对照的研究方法，构建胃癌高危评分模型。结果：受试者工作特征（receiver operating characteristic，ROC）曲线显示，当PGⅠ为43.7 μg/L时，曲线下面积最大为0.736，其灵敏度为0.529，特异度为0.779。当PGⅠ/Ⅱ为2.2 μg/L时，曲线下面积最大为0.780，其灵敏度为0.578，特异度为0.849。将二者并联时，对胃癌诊断的灵敏度为71.8%、特异度为75.5%，可确定PGⅠ≤43.7 μg/L且PGⅠ/Ⅱ≤2.1 μg/L是最佳筛查临界值。单因素分析结果显示，两组患者的性别构成、年龄、饮用水类型、家族史、食用腌制品、HP感染、PGⅠ及PGⅠ/Ⅱ等差异有统计学意义（P＜0.05）。进一步行多因素Logistic分析发现，患者性别、饮用水类型、HP感染、家族史、PGⅠ、PGⅠ/Ⅱ及年龄是影响患者胃癌发生的独立危险因素（P＜0.05）。在Logistic分析基础上，对各危险因素进行赋值，建立评分模型：Y=A×年龄+30×性别+30×饮用水+30×HP（+）+50×家族史+B×PG水平（35~45岁：A=20；46~55岁：A=40；56~65岁：A=70；≥66岁：A=80。当PGⅠ≤43.7 μg/L且PGⅠ/Ⅱ＞2.1 μg/L：B=10；PGⅠ＞43.7 μg/L且PGⅠ/Ⅱ≤2.1 μg/L：B=30；PGⅠ≤43.7 μg/L且PGⅠ/Ⅱ≤2.1 μg/L：B=80）。根据构建模型对两组患者评分进行验证，结果发现，病例组评分［（209.78±46.98）分］显著高于对照组［（122.37±56.37）分］，差异有统计学意义（χ

=13.962，P＜0.001）。ROC曲线显示，当临界值为156分时，曲线下面积最大为0.876，灵敏度为0.880，特异度为0.716，Youd

en指数=0.595。拟合优度经Hosmer-Lemeshow检验后发现，模型HL指标为13.492，P=0.095，表明模型拟合度较好。结论：根据建立的胃癌评分模型，对评分≥156且因消化道相关不适而就诊的患者，应视为高危人群，建议至少每年进行1次胃镜随访。

Abstract

Background and purpose: The opportunistic screening

also known as individual screening

is a clinic-based screening method

which is a feasible way to improve the detection rate of early gastric cancer in China. Based on the data of patients and hematological indexes

we constructed a scoring model of high risk factors for gastric cancer

and explored its value in screening gastric cancer patients. Methods: Three hundred and eighty-seven patients were enrolled in this study. We investigated the Helicobacter pylori (HP) infection

serum pepsinogen (PG)Ⅰ

PGⅠ/Ⅱ level and other indexes. The high risk assessment model of gastric cancer was constructed. Results: The receiver operating characteristic (ROC) curve showed that the maximum area under the curve was 0.736 when PGⅠ was 43.7 μg/L. When PGⅠ/Ⅱ was 2.2 μg/L

the maximum area under the curve was 0.780. PG=43.7 μg/L and PGⅠ/Ⅱ=2.1 μg/L were the best screening critical values. Gender

drinking water type

HP infection

family history

PGⅠ

PGⅠ/Ⅱ level and age were independent risk factors for gastric cancer in the patients (P0.05). On the basis of logistic regression analysis

the risk factors were assigned and the scoring model was established: Y=A×age +30×gender +30×drinking water +30×HP (+) +50×family history +B×PG level (35-45 years: A=20; 46-55 years: A=40; 56-65 years: A=70; ≥66 years: A=80. PGⅠ≤43.7 μg/L and PGⅠ/Ⅱ2.1 μg/L: B=10; PGⅠ43.7 μg/L and PGⅠ/Ⅱ≤2.1 μg/L: B=30; PGⅠ≤43.7 μg/L and PGⅠ/Ⅱ≤2.1 μg/L: B=80). According to the construction model

the scores of the two groups were verified. The results showed that the score of case group (209.78±46.98) was significantly higher than that of the control group (122.37±56.37) (χ

=13.962

P0.001). The ROC curve showed that the maximum area under the curve was 0.876 when the critical value was 156

and the Youden index was 0.595. After Hosmer-Lemeshow test

it was found that the fitting degree of the model was better. Conclusion: According to the scoring model of gastric cancer

the patients whose score ≥156 with gastrointestinal discomfort

should be regarded as high-risk population

and it is recommended to have a follow-up gastroscopy at least once a year.

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