Post written by Mimi C. Tan, MD, MPH, from the Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.

Gastric cancer is thought to develop via a progression from gastric atrophy and gastric intestinal metaplasia (GIM) in the setting of Helicobacter pylori infection. Although several risk factors for GIM have been described, there has yet to be a feasible screening strategy for gastric cancer in the United States.

We previously developed pre-endoscopy risk prediction models for the presence of GIM in a U.S. veteran population that included variables for Helicobacter pylori infection, sex, age, race/ethnicity, and smoking status. The purpose of the current study was to externally validate these models in a second U.S. population for generalizability and clinical usefulness.

GIM is considered an important precursor of gastric cancer and a promising target for screening and endoscopic surveillance to facilitate detection and treatment of early gastric cancers. U.S. societies have released guidance on treatment and surveillance after diagnosis of GIM, but there is no clear guidance on whom to screen for GIM, and this gap is in large part because of the absence of validated generalizable risk stratification tools.  

Using 423 GIM cases and 1796 controls from the Houston Veterans Affairs Hospital, we developed a risk prediction model that had an area under the receiver-operating characteristic (AUROC) curve of .73 for GIM and .82 for extensive GIM (involving antrum and corpus).

When we validated this model in a second cohort of patients from 6 Catholic Health Initiative-St Luke’s hospitals (Houston, Tex, USA) (215 GIM cases and 2469 controls), the model had an AUROC of .62 (95% confidence interval, .57-.66) for predicting GIM and .71 (95% confidence interval, .63-.79) for extensive GIM. When the Veterans Affairs and Catholic Health Initiative-St Luke’s cohorts were pooled, discrimination of both models improved (GIM AUROC, .74; extensive GIM AUROC, .82).

A risk prediction model using pre-endoscopy, measurable, readily available risk factors was able to discriminate presence of GIM in 2 populations with uniquely different demographics. This model validated in other U.S. populations may be able to risk stratify those with the greatest benefit from endoscopic screening for GIM.

Graphical Abstract

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