Development and validation of a nomogram incorporating dietary factors for predicting Helicobacter pylori-negative early gastric cancer risk

Abstract

BACKGROUND

Gastric cancer (GC) is one of the most prevalent malignant tumors worldwide and poses a significant threat to human health. Helicobacter pylori (H. pylori)-negative early GC (HpN-EGC) often remains undetected because of its asymptomatic progression.

AIM

To accurately and efficiently identify high-risk HpN-EGC individuals and guide clinical diagnosis and treatment, we developed a clinical prediction model for HpN-EGC.

METHODS

This retrospective case-control study evaluated 593 confirmed H. pylori-negative cases at a hospital. Eligible patients were randomized into training (n = 416) and internal validation (n = 177) groups. Multivariate logistic regression analysis identified significant predictors, which were incorporated into the nomogram. Patients from a different hospital were included in the external validation group (n = 109). Subgroup analyses explored H. pylori eradication (> 1 year) in H. pylori-naive populations.

RESULTS

Risk factors for HpN-EGC were advanced age [odds ratio (OR): 1.13], digestive comorbidities (OR: 17.55), and frequent consumption of smoked and hot foods (OR: 19.00; OR: 4.19). Regular legume and nut intake had protective effects (OR: 0.30; OR: 0.14). The nomogram showed excellent discrimination [training area under the curve (AUC) = 0.904; internal validation AUC = 0.865; external validation AUC = 0.794], stable calibration, and predictive accuracy, with a C-index of 0.904 (95% confidence interval: 0.876-0.931). Good model fit was supported by a non-significant Hosmer-Lemeshow test result (χ² = 7.57, P = 0.477). Subgroup analysis revealed that smoking and alcohol consumption specifically increased the risk in H. pylori-naive patients, whereas legume and nut consumption consistently reduced the risk across subgroups.

CONCLUSION

The HpN-EGC risk prediction tool effectively identifies high-risk individuals based on age, digestive comorbidities, consumption of smoked and hot foods, and legume and nut intake.

Keywords: Early gastric cancer; Helicobacter pylori; Risk factor; Prediction model; Nomogram

Core Tip: Early gastric cancer (EGC), especially Helicobacter pylori (H. pylori)-negative EGC, often goes unnoticed because of the absence of obvious clinical symptoms in patients. Our study explored the risk and protective factors associated with the development of H. pylori-negative EGC, and established a risk prediction model. The model, established based on advanced age, digestive comorbidities, and the frequent consumption of smoked and hot foods, legumes and nuts, has superior accuracy and clinical application value.