Predictive value of nomogram based on Kyoto classification of gastritis to diagnosis of gastric cancer

Abstract

Background and Aim

It is important to predict the risk of gastric cancer (GC) for endoscopists because early detection of GC determines the selection of the best treatment strategy and the prognosis of patients. The study aimed to evaluate the utility of a predictive nomogram based on the Kyoto classification of gastritis for GC.

Methods

It was a retrospective study that included 2639 patients who received esophagogastroduodenoscopy and serum pepsinogen (PG) assay from January 2019 to November 2019 at the Endoscopy Center of the Department of Gastroenterology, Wenzhou Central Hospital. Routine biopsy was conducted to determine the benign and malignant lesions pathologically. All cases were randomly divided into the training set (70%) and the validation set (30%) by using the bootstrap method. A nomogram was formulated according to multivariate analysis of the training set. The predictive accuracy and discriminative ability of the nomogram were assessed by concordance index (C-index), area under the curve (AUC) of receiver operating characteristic curve (ROC) as well as calibration curve and were validated by the validation set.

Results

Among all patients enrolled, 102 of 2636 cases showed LGIN, HGIN and gastric cancer pathology results, whereas the rest cases showed benign pathological results. Multivariate analysis indicated that age, sex, PG I/II ratio and Kyoto classification scores were independent predictive variables for GC. The C-index of the nomogram of the training set was 0.79 (95% CI: 0.74 to 0.84) and the AUC of ROC is 0.79. The calibration curve of the nomogram demonstrated an optimal agreement between predicted probability and observed probability of the risk of GC. The C-index was 0.86 (95% CI: 0.79 to 0.94) with a calibration curve of better concurrence in the validation set.

Conclusion

The nomogram formulated was proven to be of high predictive value for GC.

Keywords:

• Gastric cancer
• nomogram
• Kyoto classification of gastritis
• pepsinogen

Ethics approval and consent of participate

This population-based study complies with ethical guidelines of the Declaration of Helsinki (1975) and was approved by the Ethics Committee of the ethical review board of Wenzhou Central Hospital (number L2021-03-001x). The data were anonymous, so the requirement for informed consent was waived(the application for non informed consent has been approved by the ethics committee).

Author contributions

Lin JJ designed the study and collected data. Su H analyzed data and wrote the manuscripts. Zhou LY designed the study and revised the manuscripts. Zhou QJ collected data. Pan J revised the manuscripts and approved the final article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported by

This research was part of the projects of Wenzhou Science and Technology Bureau [Award Number: Y20180642 and Y20190608]. This research was supported by the funding body in terms of the observation service charge and the cooperation of research sites. The funding body played a less important role in the design of the study, statistics analysis, interpretation of data and in writing of the manuscript.