Preliminary Study On Risk Factors Of Gastric Cancer And The Scoring Model For High Gastric Cancer Risk Population

Gastric cancer(GC)is a common malignant tumors,and is the second largest malignant tumor after lung cancer in terms of mortality.China is a country with a high incidence of gastric cancer,accounting for about half of the world's new cases and deaths every year.Prognosis of gastric cancer is related to clinical progress.The higher the detection rate of early gastric cancer,the lower the mortality rate of tumor.Therefore,screening the high-risk population of gastric cancer is an effective measure to improve the detection rate of gastric cancer.Risk factors for gastric cancer include advanced age,helicobacter pylori(H.pylori)infection,intestinal metaplasia(IM)and gastric polyps(GP),firstdegree relatives of gastric cancer patients,smoking and heavy drinking.High risk factors related to gastric cancer play an important role in the occurrence and development of gastric cancer.Japan,South Korea and other east Asian countries have gradually carried out screening programs for gastric cancer.Gastric cancer screening techniques include gastrointestinal imaging,gastroscopy,and serum tumor markers.Imaging screening can not be directly observed in the stomach,prone to miss flat lesions,has not been the preferred screening method.The sensitivity of accurate gastroscopy is high,and it is the preferred method of gastric cancer screening to observe and carry out pathological examination with a variety of gastroscopic fine examination techniques.Gastric cancer serological screening,including serological tests such as pepsinogen(PG)and gastrin-17(G-17),is simple and economical,and is gradually being applied to the screening of gastric cancer.Objective:On the basis of fully considering the risk factors related to gastric cancer,this study established a scoring model for high-risk population of gastric cancer to assess the risk of early gastric cancer and provide scientific reference for screening patients with early gastric cancer so as to improve the diagnosis rate of early gastric cancer.Methods:347 patients with upper gastrointestinal symptoms in our hospital from December 2016 to March 2018 were selected as the research objects.General data such as gender,age,body mass index(BMI),helicobacter pylori infection and family history of gastric cancer of all patients were statistically analyzed by questionnaire.159 patients with gastric mucosa intestinal metaplasia,intraepithelial neoplasia(IN)and gastric cancer diagnosed by gastroscopy and pathology were taken as the case group.The rest 188 patients diagnosed with other chronic gastric diseases were taken as control group.At the same time,fasting venous blood 5ml was drawn to detect the serum pepsinogenI(PGI),pepsinogen I/?(PGR)and G-17 levels of all patients.Through single factor analysis of the two groups of patients with age,gender,HP infection,gastric cancer family history,PGR level and other related information,screening out the relevant high-risk factors.Through multivariate Logistic regression analysis and quantification of relevant influencing factors,a corresponding scoring model for gastric cancer high-risk population was established according to the weight and type of variables in the model.The prediction efficiency of the risk prediction model was verified by the working characteristics receiver operator characteristic curve(ROC)of the subjects.Results:1.Unifactor analysis showed that there were statistically significant differences in age,gender,body mass index,helicobacter pylori infection,family history of gastric cancer,smoking history,and long-term consumption of vegetables and fruits between the case group and the control group(P<0.05),while there were no statistically significant differences between the two groups in ethnicity,drinking history,annual income and long-term residence(P > 0.05).statistical analysis shows that gender,age,BMI,helicobacter pylori infection,family history of gastric cancer,smoking history and long-term consumption of vegetables and fruits are all factors affecting gastric precancerous lesions and gastric cancer.Multivariate logistic regression analysis showed that gender,age,BMI,HP,family history of gastric cancer and parallel connection of PGI,PGR and G-17 had influence on the occurrence of gastric cancer.Male,age?40 years old,BMI>18.5,Helicobacter pylori infection,family history of gastric cancer,PGI?70.035 ng/mL or PGR?4.960 or G17?6.005 pmol/L increased risk.2.The area under ROC curve was used to evaluate the diagnostic efficacy of PG?,PGR and G-17.The areas under ROC curve of serum PG?,PGR and G-17 are 0.783,0.806 and 0.858 respectively,and the optimal critical values are 70.035ng/mL,4.960 and 6.005 pmol/L respectively.The parallel sensitivity and specificity of PGI,PGR and G-17 are 0.874 and 0.691 respectively,while the series sensitivity and specificity of PGI,PGR and G-17 are 0.623 and 0.963 respectively.3.multi-factor logistic regression analysis established a high risk scoring model for gastric cancer as follows: Y=15×gender+A×age+10×BMI +10×HP+ 10×family history+35×joint index(1.joint index: PGI?70.035ng/mL or PGR?4.960 or G17?6.005 pmol/L 2.when 40<age<60,A=15;Age?60,A=25).The low-risk population of gastric cancer is divided into high-risk population of gastric cancer by 0~54 points and 55~105 pointsConclusion:1.Male,age?40 years old,BMI>18.5,Helicobacter pylori infection,famil y history of gastric cancer,serological detection PGI?70.035 ng/mL or PGR? 4.960 or G17?6.005 pmol/L are the influencing factors of precancerous gastric cancer and gastric cancer occurrence.2.The established gastric cancer high-risk scoring model has certain clinical application effect and prediction function,and provides convenient and convenient theoretical basis for clinical screening of gastric cancer high-risk population.