Personalized risk assessment for dynamic transition of gastric neoplasms
Journal
Journal of Biomedical Science
Journal Volume
25
Journal Issue
1
Date Issued
2018
Author(s)
Abstract
Background: To develop an individually-tailored dynamic risk assessment model following a multistep, multifactorial process of the Correa's gastric cancer model. Methods: First, we estimated the state-to-state transition rates following Correa's five-step carcinogenic model and assessed the effect of risk factors, including Helicobacter pylori infection, history of upper gastrointestinal disease, lifestyle, and dietary habits, on the step-by-step transition rates using data from a high-risk population in Matsu Islands, Taiwan. Second, we incorporated information on the gastric cancer carcinogenesis affected by genomic risk factors (including inherited susceptibility and irreversible genomic changes) based on literature to generate a genetic and epigenetic risk assessment model by using a simulated cohort identical to the Matsu population. The combination of conventional and genomic risk factors enables us to develop the personalized transition risk scores and composite scores. Results: The state-by-state transition rates per year were 0.0053, 0.7523, 0.1750, and 0.0121 per year from normal mucosa to chronic active gastritis, chronic active gastritis to atrophic gastritis, atrophic gastritis to intestinal metaplasia, and intestinal metaplasia to gastric cancer, respectively. Compared with the median risk group, the most risky decile had a 5.22-fold risk of developing gastric cancer, and the least risky decile around one-twelfth of the risk. The median 10-year risk for gastric cancer incidence was 0.77%. The median lifetime risk for gastric cancer incidence was 5.43%. By decile, the 10-year risk ranged from 0.06 to 4.04% and the lifetime risk ranged from 0.42 to 21.04%. Conclusions: We demonstrate how to develop a personalized dynamic risk assessment model with the underpinning of Correa's cascade to stratify the population according to their risk for progression to gastric cancer. Such a risk assessment model not only facilitates the development of an individually-tailored preventive strategy with treatment for H. pylori infection and endoscopic screening but also provides short-term and long-term indicators to evaluate the program effectiveness. ? 2018 The Author(s).
SDGs
Other Subjects
adult; Article; atrophic gastritis; cancer incidence; cancer model; cancer risk; cancer susceptibility; chronic gastritis; controlled study; epigenetics; feeding behavior; gastrointestinal disease; genetic risk; genetic susceptibility; Helicobacter infection; high risk population; human; intestine metaplasia; island (geological); lifestyle; major clinical study; personalized medicine; population genetics; priority journal; risk assessment; risk factor; risk reduction; scoring system; simulation; stomach cancer; stomach carcinogenesis; stomach mucosa; upper gastrointestinal tract; aged; carcinogenesis; chemically induced; cohort analysis; disease exacerbation; environment; genetic epigenesis; genetics; incidence; middle aged; mortality; risk factor; stomach tumor; Taiwan; theoretical model; environmental marker; Adult; Aged; Carcinogenesis; Cohort Studies; Disease Progression; Environment; Environmental Biomarkers; Epigenesis, Genetic; Humans; Incidence; Middle Aged; Models, Theoretical; Risk Assessment; Risk Factors; Stomach Neoplasms; Taiwan
Publisher
BioMed Central Ltd.
Type
journal article