| ObjectiveTo compare the differences in serum levels of clinical hematological indicators between gastric cancer and benign gastric diseases(including gastric ulcer,chronic gastritis and gastric polyps).Furthermore,to evaluate the diagnostic value of each indicator and establish a diagnostic model for gastric cancer based on hematological indicators,so as to provide a simple and efficient new method for screening and diagnosis of gastric cancer.MethodsThe clinical data of hospitalized patients with gastric cancer or benign gastric diseases were collected,including general information,blood routine,biochemical tests,coagulation tests,tumor markers and so on.The serological differences of these serum markers between benign and malignant gastric diseases were analyzed and compared.Patients with gastric cancer were selected as the experimental group,and patients with benign gastric disease were selected as the control group.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to evaluate the diagnostic value of serological indicators for gastric cancer.Then,the subjects were randomly divided into training group and validation group at a ratio of7:3.In the training group,LASSO and Logistic regression analysis were performed to establish the diagnosis model of gastric cancer based on hematological indicators,called H model.Meanwhile,another diagnostic model was established based on tumor markers CEA,CA199 and CA724,which was called T model.The diagnostic value of H model for gastric cancer was evaluated in the validation group,and the diagnostic accuracy of H model and T model was compared.The significance of hematological parameters in the diagnosis of gastric cancer was evaluated.Finally,the mean H model scores of gastric cancer patients with different clinical characteristics were compared to explore the relationship between H model scores and gastric cancer progression.Results1.A total of 316 patients with gastric cancer and 374 patients with benign gastric diseases were included,including 70 patients with gastric ulcer,144 patients with chronic gastritis and 160 patients with gastric polyps.The male to female ratio and smoking history of the gastric cancer were higher,and the body mass index(BMI)was lower than those of the benign gastric disease.There were no significant differences in age,drinking history and helicobacter pylori infection rate between the two groups.2.The results of difference analysis suggested that there were significant serological differences in most hematological indicators between patients with gastric cancer and benign gastric disease.Univariate Logistic regression analysis and ROC analysis suggested that most hematological indicators had certain diagnostic value for gastric cancer.Among them,the top five indicators with the highest AUC value were Albumin to fibrinogen ratio(AFR)(0.746),cholinesterase(CHE)(0.744),D-dimer(D-D)(0.714),C-reactive protein to albumin ratio(CAR)(0.703),albumin(ALB)(0.698).3.Finally,14 hematological indicators were included to establish the H model for the diagnosis of gastric cancer,including: C-reactive protein(CRP),hemoglobin(HGB),platelet(PLT),lymphocyte(LYM),aspartate aminotransferase/alanine aminotransferase ratio(SLR),CHE,creatinine(Cr),total cholesterol(TC),triglyceride(TG),homocysteine(HCY),fibrinogen(FIB),D-D,CEA,and CA199.The H model had high diagnostic accuracy of gastric cancer,and its AUC values were0.883 in the training group and 0.836 in the validation group,which were significantly higher than those of the T model(P < 0.001).The Hosmer-Lemeshow test showed that the predicted results of the H model had a good fit with the actual observed results(P > 0.05).DCA curve showed that the H model had higher clinical benefit than T model and tumor markers.NRI > 0,which confirmed that the predictive ability of the H model was significantly improved compared with the T model.4.The H model scores of patients with tumor size > 3cm,with lymph node or distant metastasis,with nerve or vascular invasion,were higher than those of patients with tumor size ≤ 3cm,without lymph node or distant metastasis,or without nerve or vascular invasion.In addition,the deeper the tumor invasion and the more advanced TNM stage,the higher the H model score.However,there was no significant difference in H model scores of gastric cancer patients with different gender,helicobacter pylori infection,Borrmann classification and Lauren classification(P >0.05).ConclusionThe results of this study show that the serum levels of most blood routine,blood biochemistry,coagulation,tumor markers and CRP were significantly different between gastric cancer and benign gastric diseases.The nomogram model of gastric cancer based on hematological indicators can effectively distinguish benign and malignant gastric diseases,and its predictive ability is significantly improved compared with tumor markers.The H model score was correlated with the pathological characteristics of gastric cancer,suggesting that the hematological parameters involved in the construction of the model were related to the progression of gastric cancer. |
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