Personalized starting age of gastric cancer screening based on individuals' risk profiles: a population-based, prospective study.

IF 9.9 1区 医学 Q1 ONCOLOGY JNCI Journal of the National Cancer Institute Pub Date : 2024-11-01 DOI:10.1093/jnci/djae162
Siyi He, Zhiyi Zhang, Guohui Song, Zhenhai Wang, He Li, Maomao Cao, Fan Yang, Dianqin Sun, Xinxin Yan, Shaoli Zhang, Yi Teng, Qianru Li, Changfa Xia, Wanqing Chen
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Abstract

Background: The current recommended starting age for gastric cancer screening lacks unified guideline and individualized criteria. We aimed to determine the risk-stratified starting age for gastric cancer screening in China based on individuals' risk profiles and to develop an online calculator for clinical application.

Methods: In this multicenter, population-based, prospective study, we allocated participants enrolled between 2015 and 2017 (N = 59 771, aged 40-69 years) to screened and unscreened groups and observed them for primary endpoints: gastric cancer occurrence as well as all-cause and gastric cancer-specific death. Median follow-up was 6.07 years. To determine the reference starting age, the effectiveness of gastric cancer screening was assessed by age group after propensity score matching. Further, we categorized the calculated individual risk scores (using well-established risk factors) by quantile. Subsequently, we used age-specific, 10-year cumulative risk curves to estimate the risk-stratified starting age-that is, when the individual's risk level matches the reference starting age risk threshold.

Results: During follow-up, 475 gastric cancer case patients, 182 gastric cancer-related deaths, and 1860 all-cause deaths occurred. All-cause and gastric cancer-specific mortality decreased among screened individuals 45 years of age and older and 50 to 59 years of age, respectively. Thus, the average population (referent) starting age was set as 50 years. The 10-year cumulative risk of gastric cancer in the average population aged 50 years was 1.147%. We stratified the starting age using 8 risk factors and categorized participants as low-risk, medium-risk, and high-risk individuals whose risk-stratified starting age was 58, 50, and 46 years, respectively.

Conclusion: Although high-risk individuals warrant starting gastric cancer screening 3 to 5 years earlier than for the average population (aged 50 years), low-risk individuals can tolerate delayed screening. Our online, personalized starting age calculator will help with risk-adapted gastric cancer screening (https://web.consultech.com.cn/gastric/#/).

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基于个人风险特征的个性化胃癌筛查起始年龄:一项基于人群的前瞻性研究。
背景:目前推荐的胃癌(GC)筛查起始年龄缺乏统一指南和个体化标准。我们旨在根据个体的风险特征,确定中国胃癌筛查的风险分层起始年龄,并开发在线计算器供临床应用:在这项多中心人群前瞻性研究中,我们将2015-2017年期间入组的参与者(n = 59,771,年龄在40-69岁之间)分为筛查组和未筛查组,并观察他们的主要终点--GC发生率、全因和GC特异性死亡。中位随访时间为 6.07 年。为了确定参考起始年龄,我们在倾向分数匹配后按年龄组评估了胃癌筛查的有效性。此外,我们还将计算出的个人风险评分(使用已确定的风险因素)按量级进行了分类。随后,我们使用年龄特异性 10 年累积风险曲线来估算风险分层起始年龄--当个人风险水平符合参考起始年龄风险阈值时:在随访期间,共有 475 例 GC 病例、182 例 GC 死亡病例和 1,860 例全因死亡病例。年龄≥45岁和50-59岁的筛查对象的全因死亡率和GC特异性死亡率分别有所下降。因此,平均人口(参考)起始年龄定为 50 岁。在 50 岁的平均人群中,GC 的 10 年累积风险为 1.147%。我们利用八个风险因素对起始年龄进行了分层,并将参与者分为低、中、高风险人群,其风险分层后的起始年龄分别为 58 岁、50 岁和 46 岁:结论:虽然高风险人群需要比普通人群(50 岁)提前 3-5 年进行 GC 筛查,但低风险人群可以接受延迟筛查。我们的在线个性化起始年龄计算器将有助于根据风险调整 GC 筛查 (https://web.consultech.com.cn/gastric/#/)。
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来源期刊
CiteScore
17.00
自引率
2.90%
发文量
203
审稿时长
4-8 weeks
期刊介绍: The Journal of the National Cancer Institute is a reputable publication that undergoes a peer-review process. It is available in both print (ISSN: 0027-8874) and online (ISSN: 1460-2105) formats, with 12 issues released annually. The journal's primary aim is to disseminate innovative and important discoveries in the field of cancer research, with specific emphasis on clinical, epidemiologic, behavioral, and health outcomes studies. Authors are encouraged to submit reviews, minireviews, and commentaries. The journal ensures that submitted manuscripts undergo a rigorous and expedited review to publish scientifically and medically significant findings in a timely manner.
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