Development of a gastric cancer risk calculator for questionnaire-based surveillance of Iranian dyspeptic patients
Abstract:
Background Gastric cancer (GC) is considered a silent killer, taking more than three quarters of a million lives annually. Therefore, prior to further costly and invasive diagnostic approaches, an initial GC risk screening is desperately
in demand.
Methods In order to develop a simple risk scoring system, the demographic and lifestyle indices from 858 GC
and 1132 non-ulcer dyspeptic (NUD) patients were analysed. We applied a multivariate logistic regression approach
to identify the association between our target predictors and GC versus NUD. The model performance in classifcation
was assessed by receiver operating characteristic (ROC) analysis. Our questionnaire covering 64 predictors, included
known risk factors, such as demographic features, dietary habits, self-reported medical status, narcotics use, and SES
indicators.
Results Our model segregated GC from NUD patients with the sensitivity, specifcity, and accuracy rates of 85.89,
63.9, and 73.03%, respectively, which was confrmed in the development dataset (AUC equal to 86.37%, P <0.0001).
Predictors which contributed most to our GC risk calculator, based on risk scores (RS) and shared percentages (SP),
included: 1) older age group [>70 (RS:+241, SP:7.23), 60–70 (RS:+221, SP:6.60), 50–60 (RS:+134, SP:4.02), 2) history
of gastrointestinal cancers (RS:+173, SP:5.19), 3) male gender (RS:+119, SP:3.55), 4) non-Fars ethnicity (RS:+89, SP:2.66),
5) illiteracy of both parents (RS:+78, SP:2.38), 6) rural residence (RS:+77, SP:2.3), and modifable dietary behaviors
(RS:+32 to +53, SP:0.96 to 1.58).
Conclusion Our developed risk calculator provides a primary screening step, prior to the subsequent costly and invasive measures. Furthermore, public awareness regarding modifable risk predictors may encourage and promote
lifestyle adjustments and healthy behaviours.