The Department of Cancer Prevention and Control, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
Department of Pathology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
Cancer Med. 2020 Nov;9(22):8722-8732. doi: 10.1002/cam4.3462. Epub 2020 Sep 16.
Upper gastrointestinal precancerous lesions (UGPL) is the major preventable disease in non-high-incidence area. A prognostic nomogram was constructed to predict and identity susceptible population of UGPL before endoscope screening.
We recruited 300 ,016 eligible participants for upper gastrointestinal cancer (UGC) screening aged 40-74 years from two cities in Hunan province from 2012 to 2019. Individuals at high risk of UGC on basis of questionnaire estimation underwent endoscopic screening. Participants in two cities accepting endoscopy were used as training and external validation cohorts, respectively. A nomogram was developed based on independent prognostic factors of UGPL determined in multivariable logistic regression analysis.
Of 35, 621 with high risk for UGC, 10, 364 subjects undertook endoscopy (participation rate of 29.1%). The detection rate for UGPL was 4.55%. The nomogram showed that age, gender, mental trama, picked food, and atrophic gastritis history in a descending order were significant contributors to UGPL risk. The C-index value of internal and external validation of the model is 0.612 and 0.670, respectively. The calibration data for UGPL showed optimal agreement between the nomogram prediction and actual observation. Furthermore, high-risk and low-risk group divided based on score from the nomogram predicted a significantly distinct detection rate.
The nomogram provides screening workers a simple and accurate tool for identifying individuals at a higher risk of UGPL as primary screening before endoscopy among Chinese population in non-high-risk areas, thus reducing the incidence of UGC by improving the UGPL detection.
上消化道癌前病变（UGPL）是高发地区以外主要的可预防疾病。本研究构建了一个预测和识别上消化道内镜筛查前高危人群的列线图。
我们招募了 2012 年至 2019 年湖南省两个城市年龄在 40-74 岁的 300016 名上消化道癌（UGC）筛查合格参与者。根据问卷调查估计，UGC 高危人群接受内镜筛查。两个城市接受内镜检查的参与者分别作为训练和外部验证队列。基于多变量逻辑回归分析确定的 UGPL 独立预后因素，建立了一个列线图。
在 35621 名 UGC 高危人群中，有 10364 名接受了内镜检查（参与率为 29.1%）。UGPL 的检出率为 4.55%。列线图显示，年龄、性别、精神创伤、挑食和萎缩性胃炎史依次是 UGPL 风险的重要因素。模型内部和外部验证的 C 指数值分别为 0.612 和 0.670。UGPL 的校准数据显示，列线图预测与实际观察之间具有最佳一致性。此外，根据列线图评分将高危和低危组进行分组，可以预测出显著不同的检出率。
该列线图为筛查工作人员提供了一种简单而准确的工具，可用于识别中国非高危地区人群在上消化道内镜筛查前 UGPL 风险较高的个体，从而通过提高 UGPL 的检出率来降低 UGC 的发病率。
