Patient characteristics

A total of 25,194 asymptomatic participants were surveyed. According to the new scoring system for EGC screening [11], a total of 8009 patients were categorized as having a medium–high risk of GC, among which 7360 (91.90%) patients were classified as having a medium risk of GC and 649 (8.10%) as having a high risk of GC. The age of the medium–high GC risk group ranged from 41 to 89 years, and included 7186 men with average (± SD) age of 57.73 (± 7.38) years and 823 women with an average (± SD) age of 66.32 (± 7.31) years; the sex ratio was 8.73:1.

Results of gastroscopy

Participants with a medium or high risk of GC were advised to undergo gastroscopy, and 1019 individuals finally completed gastroscopy; the response rate for gastroscopy was 12.72%. Of these, we identified 655 participants with non-atrophic gastritis (388 with chronic superficial gastritis, 267 with erosive gastritis), 52 patients with atrophic gastritis, 109 with gastric ulcer, 79 with non-neoplastic polyps, 94 with precancerous lesion (69 patients with intestinal-type gastritis, 25 with LGIN), 12 patients with early-stage cancer (9 with HGIN, 1 with gastric intramucosal carcinoma, 2 with early esophageal carcinoma), 15 patients with advanced cancer (14 with AGC, 1 with advanced esophageal carcinoma), and 3 patients with gastric stromal tumor. Additionally, 648 participants with a low risk of GC underwent gastroscopy and no GC cases were identified (Table 2).

Table 2 Characteristics of patients underwent gastroscopy in the medium–high risk of GC groups

Among the 14 patients with AGC, lesions located in the gastric antrum, cardia, gastric body, and gastric angle were found in 5, 3, 3, and 3 patients, respectively. Two patients had high differentiation, eight had medium differentiation, and four patients had low differentiation. Additionally, four patients had infiltration of the muscle layer and 10 had infiltration of the serous layer. Ten patients with EGC and three patients with gastric stromal tumor were completely resected via ESD. Of the 25 patients with LGIN, 11 requested treatment, and all lesions were successfully removed using ESD.

Serum PG and G-17 and Hp status in each group

As shown in Table 3, compared with the group who had non-atrophic gastritis as the control group, the serum levels of PGI were significantly increased in the gastric ulcer group (P < 0.05); however, the atrophic gastritis group, precancerous lesion group, EGC group, and AGC group had lower PGI levels (P < 0.05). The gastric ulcer group, non-neoplastic polyp group, precancerous lesion group, EGC group, and AGC group had higher PGII and G-17 levels than the non-atrophic gastritis group. The expression levels of PGR in the atrophic gastritis group, non-neoplastic polyp group, precancerous lesion group, EGC group, and AGC group were significantly lower than those in the non-atrophic gastritis group (P < 0.05). The positive rate of Hp increased gradually in the non-atrophic gastritis group, non-neoplastic polyp group, atrophic gastritis group, EGC group, precancerous lesion group, gastric ulcer group, and AGC group (P < 0.05). Serum levels of PGI, PGII, PGR, G-17, and rates of HP infection were significantly different among groups (P < 0.05).

Table 3 Serum PG, G-17 and status of HP in each group

ROC curves for diagnostic cutoffs of PG, G17, and Hp in GC

Patients with EGC and AGC were selected as the case group (n = 24) and those with non-atrophic gastritis, atrophic gastritis, gastric ulcer, non-neoplastic polyps, and precancerous lesions were selected as the contrast group (n = 995). As shown in Fig. 1 and Table 4, serum levels of PGI, PGII, PGR, G-17, and infection with Hp had diagnostic value for GC, among which the area under the ROC curve (AUC) of PGII, G-17, and Hp was higher than for the other two serum indicators (PGI and PGR). For PGII, the AUC was 0.636 (95% confidence interval [CI] 0.545–0.726), and the sensitivity and specificity of PGII in diagnosing GC were 92.6% and 37.5%, respectively. For G-17, the AUC was 0.621 (95% CI 0.533–0.710); the sensitivity and specificity of PGII in diagnosing GC were 100% and 25.4%, respectively. For Hp, the AUC was 0.573 (95% CI 0.466–0.681), and the sensitivity and specificity of Hp in diagnosing GC were 63% and 51.7%, respectively. The sensitivity, specificity, and AUC of the combination of PGI, PGII, PGR, G-17, and Hp in diagnosing GC were 81.5%, 77.8%, and 0.817 (95% CI 0.721–0.913), respectively.

Fig. 1
figure 1

Receiver operating characteristic (ROC) curves for diagnosing gastric cancer (GC). ROC curve of combined is means the combination of PGI, PGII, PGR, G-17, and Hp for diagnosing GC

Table 4 The accuracy of different serum gastric markers in diagnosing GC

Screening efficiency of the new scoring system for GC in the Wannan region

In our study, in patients with a medium–high risk of GC, the overall detection rate of GC was 2.36% (24/1019). There were 648, 919 and 100 patients in the low-, medium-, and high-risk of GC groups, respectively. The detection rate of GC in the low-, medium- and high-risk groups was 0% (0/648), 1.63% (15/919), and 9% (9/100), respectively (P < 0.001).

Risk factors of GC in the Wannan region

We carried out univariate analysis to explore the risk factors for GC in the investigated population. The results suggested that there were no statistically significant differences between the two groups in terms of BMI; family history of GC; a history of drinking; and frequently consuming smoked, barbecued and overnight leftover foods (P > 0.05). GC and precancerous lesions were more frequently found in patients with age ≥ 60 years old, male sex, Hp infection, and a history of smoking (P < 0.05). Patients who ate a high-salt diet, and those who frequently consumed pickled and fried foods were more likely to have GC and precancerous lesions (P < 0.05); however, patients who frequently consumed green vegetables and fresh fruits were less likely to have GC and precancerous lesions (P < 0.05) (Table 5).

Table 5 Univariate analysis and multivariate analysis of risk factors for GC and precancerous lesions in the Wannan region

Multivariate analysis of risk factors for GC in the Wannan region

We conducted a multivariate analysis of the risk factors for GC in the Wannan region. The results showed that age (odds ratio [OR], 5.934; 95% CI 3.695–9.529; P < 0.001), sex (OR 5.721; 95% CI 2.579–12.695; P < 0.001), Hp infection (OR 1.992; 95% CI 1.255–3.163; P = 0.003), a history of smoking (OR 2.028; 95% CI 1.213–3.392; P = 0.007), consuming a high-salt diet (OR 2.877; 95% CI 1.807–4.580; P < 0.001), frequent consumption of pickled foods (OR 1.873; 95% CI 1.125–3.120; P = 0.016) and frequent consumption of fried foods (OR 2.459; 95% CI 1.384–4.369; P = 0.002) were independent risk factors for GC and precancerous lesions (P < 0.05). However, frequent consumption of green vegetables (OR 0.388; 95% CI 0.242–0.620; P < 0.001) was an independent protective factor against GC and precancerous lesions (Table 5).

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