title: A tool to predict risk for gastric cancer in patients with peptic ulcer disease on the basis of a nationwide cohort.
abstract: OBJECTIVE
  Patients with gastric ulcers have significantly higher risk of gastric cancer, especially within 2 years after diagnosis. We used data from a national database to develop a personalized risk prediction model for patients with peptic ulcer diseases.
  
  
  METHODS
  We collected data from Taiwan's National Health Insurance Research Database on 278,898 patients admitted for the first time with a primary diagnosis of peptic ulcer disease. We used the data to develop a nomogram, which we validated by discrimination and calibration, and in a test cohort. Cumulative incidences of study subjects predicted by the nomogram were examined.
  
  
  RESULTS
  In total, 1269 subjects developed gastric cancer. Age, sex, peptic ulcer sites, peptic ulcer complications, Helicobacter pylori eradication, nonsteroidal anti-inflammatory drug use, and surveillance endoscopy were independent factors associated with risk of gastric cancer (all P < .001). The concordance index for the nomogram developed on the basis of these factors was 0.78. Study subjects were divided into quartiles of predicted risk scores; from lowest score quartile to highest, cumulative incidences at 1 year were 7.4/10,000 people, 14.2/10,000 people, 25.5/10,000 people, and 86.6/10,000 people. The cumulative incidences at 2 years were 9.3/10,000 people, 20.9/10,000 people, 38.0/10,000 people, and 135.7/10,000 people for the same quartiles of risk scores. The nomogram was validated in an independent cohort, and similar incidence values were determined.
  
  
  CONCLUSIONS
  We developed and validated a nomogram to predict risk for gastric cancer 1 and 2 years after diagnosis of peptic ulcer disease. The nomogram provides a prognostic tool that can be easily used for individuals and can help physicians explain risk levels to patients.
authors.affiliation: Graduate Institute of Clinical Medicine Science, China Medical University, Taichung, Taiwan; Department of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Teng-Yu
authors.initials: TY
authors.lastname: Lee
authors.affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: Chang-Bi
authors.initials: CB
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Tzu-Ting
authors.initials: TT
authors.lastname: Chen
authors.affiliation: Taipei Medical University, Taipei, Taiwan.
authors.forename: Ken N
authors.initials: KN
authors.lastname: Kuo
authors.affiliation: Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.affiliation: School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Internal Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan; Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
authors.affiliation: Graduate Institute of Clinical Medicine Science, China Medical University, Taichung, Taiwan; Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan. Electronic address: chun@vghtc.gov.tw.
authors.forename: Chun-Ying
authors.initials: CY
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D010437:Peptic Ulcer / Q000150:complications*; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology
keywords: H pylori; Inflammation; Stomach Cancer; Surveillance