Risk Score Using Demographic and Clinical Risk Factors Predicts Gastric Intestinal Metaplasia Risk in a U.S. Population

Abstract

Background/Aims Screening for gastric intestinal metaplasia (GIM) may lead to early gastric cancer detection. We developed and validated a pre-endoscopy risk prediction model for detection of GIM based on patient-level risk factors in a U.S. population. Methods We used data from 423 GIM cases and 1796 controls from a cross-sectional study among primary care and endoscopy clinic patients at the Houston VA. We developed the model using backwards stepwise regression and assessed discrimination using area under the receiver operating characteristic (AUROC). The model was internally validated using cross-validation and bootstrapping. The final expanded model was compared to a model including H. pylori infection alone and a baseline model including remaining terms without H. pylori. Results Male sex, older age, non-white race/ethnicity, smoking status, and H. pylori were associated with GIM risk. The expanded model including these terms had AUROC 0.73 (95%CI 0.71-0.76) for predicting GIM and AUROC 0.82 (95%CI 0.79-0.86) for extensive GIM. This model discriminated better than a model including only H. pylori (AUROC 0.66; 95%CI 0.63-0.68) and the baseline model (AUROC 0.67; 95%CI 0.64-0.70). The expanded model performed similarly among primary care (AUROC 0.75) and endoscopy (AUROC 0.73) patients. The expanded model showed sufficient internal validity (cross-validation AUROC 0.72) with little evidence of over-fitting. Conclusions We develop and validate a non-invasive risk model for GIM detection in a U.S. population that included terms for sex, age, race/ethnicity, smoking status, and H. pylori infection. Validated risk models would identify individuals with GIM who should be referred for endoscopic screening.

Stomach Cancer Prediction Model (SCoPM): An approach to risk stratification in a diverse U.S. population

“…Among lower prevalence nations, the European Prospective Investigation into Cancer and Nutrition cohort study involved multiple European countries, establishing a composite “healthy-lifestyle index” which was made up of modifiable lifestyle factors such as smoking status, weight, diet quality, and alcohol consumption [ 21 ]. In addition, a recently developed model based on a case-control study in the Veterans Affairs health system showed promise for identification of gastric intestinal metaplasia [ 22 ]. The present study expands on these prior efforts by focusing on risk of gastric cancer in a racially/ethnically diverse low-prevalence regional population in the United States using exclusively parameters routinely available in clinical practice.…”

Metabolic Factors Associated with Endoscopic Atrophy, Intestinal Metaplasia, and Gastric Neoplasms in Helicobacter pylori-Positive Patients

“…Several previous studies have shown that age, male sex, and H. pylori status are independent risk factors for IM and can be used as predictive models for IM [ 19 , 20 ]. However, metabolic factors, including DM, HT, DL, HUA, aortic calcification, fatty liver, and fib4 index, could improve the accuracy of predicting IM.…”