背景：缺乏有效的风险预测模型来进行个性化的胃癌内镜筛查。我们的目标是发展，验证,并评估基于问卷的GC风险评估工具，用于中国人群的风险预测和分层。
方法：在这项三阶段多中心研究中，我们首先通过Cox回归模型选择合格变量，并根据中国嘉道理生物库的416,343名受试者（年龄40-75岁）的回归系数构建GC风险评分（GCRS）（CKB，发展队列)。在相同的年龄范围内，我们在另一个独立的常州队列(验证队列)的13,982名受试者以及在扬州的内镜筛查项目的5348名受试者中验证了GCRS的有效性.最后,我们将参与者分类为低(底部20%)，中间（20-80%），和高风险（前20％）组的GCRS分布在发展队列中。
结果：使用11个基于问卷的变量的GCRS在两个队列中显示出0.754（95％CI，0.745-0.762）和0.736（95％CI，0.710-0.761）的HarrellC指数，分别。在验证队列中，十年风险为0.34%，1.05%,低(≤13.6)的个体为4.32%，中间体(13.7~30.6)，和高(≥30.7)GCRS，分别。在内窥镜检查计划中，GC的检出率在低GCRS个体中从0.00%变化，中间GCRS为0.27%，至2.59%，具有较高的GCRS。81.6%的GC病例来自高GCRS组，占所有筛查参与者的28.9%。
结论：GCRS可以成为中国量身定做的GC内镜筛查的有效风险评估工具。由自己评估胃癌的风险（RESCUE），开发了一个在线工具来帮助使用GCRS。
Effective risk prediction models are lacking for personalized endoscopic screening of gastric cancer (GC). We aimed to develop, validate, and evaluate a questionnaire-based GC risk assessment tool for risk prediction and stratification in the Chinese population.
In this three-stage multicenter study, we first selected eligible variables by Cox regression models and constructed a GC risk score (GCRS) based on regression coefficients in 416,343 subjects (aged 40-75 years) from the
China Kadoorie Biobank (CKB, development cohort). In the same age range, we validated the GCRS effectiveness in 13,982 subjects from another independent Changzhou cohort (validation cohort) as well as in 5348 subjects from an endoscopy screening program in Yangzhou. Finally, we categorized participants into low (bottom 20%), intermediate (20-80%), and high risk (top 20%) groups by the GCRS distribution in the development cohort.
The GCRS using 11 questionnaire-based variables demonstrated a Harrell\'s C-index of 0.754 (95% CI, 0.745-0.762) and 0.736 (95% CI, 0.710-0.761) in the two cohorts, respectively. In the validation cohort, the 10-year risk was 0.34%, 1.05%, and 4.32% for individuals with a low (≤ 13.6), intermediate (13.7~30.6), and high (≥ 30.7) GCRS, respectively. In the endoscopic screening program, the detection rate of GC varied from 0.00% in low-GCRS individuals, 0.27% with intermediate GCRS, to 2.59% with high GCRS. A proportion of 81.6% of all GC cases was identified from the high-GCRS group, which represented 28.9% of all the screened participants.
The GCRS can be an effective risk assessment tool for tailored endoscopic screening of GC in
China. Risk Evaluation for Stomach Cancer by Yourself (RESCUE), an online tool was developed to aid the use of GCRS.
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