Article(id=1322168642620477584, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168329855418548, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.07.002, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1737561600000, receivedDateStr=2025-01-23, revisedDate=1767715200000, revisedDateStr=2026-01-07, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159169106, onlineDateStr=2026-10-28, pubDate=1775750400000, pubDateStr=2026-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159169106, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159169106, creator=13701087609, updateTime=1793159169106, updator=13701087609, issue=Issue{id=1322168329855418548, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='7', pageStart='1057', pageEnd='1240', issueExtLink='null', onlineDate='null', pubDate='1775750400000', pubDateStr='2026-04-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159094536, creator='13701087609', updateTime=1793159094536, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1070, endPage=1080, ext={EN=ArticleExt(id=1322168642918273169, articleId=1322168642620477584, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Construction of a risk prediction model for gastric cancer based on random forest, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To construct a risk prediction model for gastric cancer in Sichuan province and to identify its predictive factors.

Methods

A total of 378 patients diagnosed with gastric cancer in four medical institutions in Sichuan province from July 2021 to August 2022 were selected as the case group.A total of 378 healthy individuals undergoing physical examinations during the same period were selected as the control group.The random forest method was used to construct a risk prediction model for gastric cancer.The performance of the model was evaluated by using accuracy,sensitivity,specificity,area under the ROC curve(AUC),calibration curve,and decision curve analysis(DCA).

Results

Educational level,occupation,white meat intake,processed meat intake,coarse grain intake,pickled and sun dried food intake,dietary taste,dietary coldness and heat,eating speed,breakfast status,smoking status,alcohol consumption,tea drinking status,history of superficial gastritis,atrophic gastritis,gastric ulcer,hypertension,hyperlipidemia,family history of cancer,and personality were independent influencing factors for gastric cancer.The top three influencing factors in terms of importance score were occupation,education level,and smoking status.The accuracy of the prediction model was 99.8%.The sensitivity was 100.0%.The specificity was 99.6%.The AUC was 0.999(95%CI 0.998-1.000).The calibration curve of the prediction model indicated good consistency between the model and the actual observation results.The DCA curve suggested that the model has good clinical efficacy in predicting gastric cancer.

Conclusions

The risk prediction model for gastric cancer of Sichuan province constructed based on the random forest method in this study has good predictive performance and is helpful for early identification of high-risk population for gastric cancer.

, authors=Qingqing WANG1, Wenbo WU1, Shaoping WAN1, Linglin ZHANG2, Yuting LI3, Lilou RONG1, authorsList=Qingqing WANG, Wenbo WU, Shaoping WAN, Linglin ZHANG, Yuting LI, Lilou RONG, authorCompany=null, correspAuthors=Wenbo WU, authorNote=null, correspAuthorsNote=
WU Wenbo, E-mail:
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322168645682319514, articleId=1322168642620477584, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=基于随机森林构建胃癌风险预测模型, columnId=1220689484681761433, journalTitle=护理研究, columnName=科研论著, runingTitle=null, highlight=null, articleAbstract=
目的

构建四川省胃癌风险预测模型并识别预测因子。

方法

选取2021年7月—2022年8月四川省4所医疗机构确诊为胃癌的378例病人为病例组,选取同期体检的378名健康者为对照组,采用随机森林法构建胃癌风险预测模型,采用准确率、灵敏度、特异度、受试者工作特征(ROC)曲线下面积(AUC)、校准曲线、决策曲线(DCA)评价模型性能。

结果

文化程度、职业、白肉摄入量、加工肉摄入量、粗粮摄入量、腌晒食品摄入量、饮食口味、饮食冷热度、进食速度、早餐情况、吸烟情况、饮酒情况、饮茶情况、浅表性胃炎疾病史、萎缩性胃炎疾病史、胃溃疡疾病史、高血压、高血脂、癌症家族史、性格是胃癌的独立影响因素。影响因素重要性评分前3位为:职业、文化程度、吸烟情况。预测模型的准确率为99.8%,灵敏度为100.0%,特异度为99.6%,AUC值为0.999[95%CI(0.998,1.000)]。预测模型校准曲线提示模型与实际观测结果存在较好的一致性;DCA曲线提示该模型预测胃癌具备良好的临床效用。

结论

基于随机森林法构建的四川省胃癌风险预测模型具有较好的预测效能,有助于早期识别胃癌高危人群。

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王青青,主管技师,硕士研究生

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武文博,E-mail:
WU Wenbo, E-mail:
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unstructuredReference=沙宇婷,王雪威,王宝华.中国南方胃癌危险因素病例-对照研究Meta分析[J].中华肿瘤防治杂志,2020,27(15):1269-1276., articleTitle=中国南方胃癌危险因素病例-对照研究Meta分析, refAbstract=null), Reference(id=1322530781201809946, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168642620477584, doi=null, pmid=null, pmcid=null, year=2021, volume=13, issue=17, pageStart=21451, pageEnd=21469, url=null, language=null, rfNumber=29, rfOrder=28, authorNames=DUAN F J, SONG C H, SHI J C, journalName=Aging, refType=null, unstructuredReference=DUAN F J,SONG C H,SHI J C,et al.Identification and epidemiological evaluation of gastric cancer risk factors:based on a field synopsis and meta-analysis in Chinese population[J].Aging,2021,13(17):21451-21469., articleTitle=Identification and epidemiological evaluation of gastric cancer risk factors:based on a field synopsis and meta-analysis in Chinese population, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322530771953369536, tenantId=1146029695717560320, 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tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168642620477584, language=EN, label=Table 1, caption=

Univariate analysis results of influencing factors of gastric cancer

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项目分类对照组(n=378)病例组(n=378)统计值P
年龄40~<50岁48(12.7)53(14.0)Z=-0.8900.373
50~<60岁143(37.8)143(37.8)
60~<70岁121(32.0)131(34.7)
≥70岁66(17.5)51(13.5)
性别男245(64.8)265(70.1)χ2=2.4100.121
女133(35.2)113(29.9)
民族汉族356(94.2)353(93.4)χ2=0.2040.651
其他22(5.8)25(6.6)
婚姻状况已婚348(92.1)347(91.8)χ2=0.0180.894
其他30(7.9)31(8.2)
文化程度小学及以下72(19.0)158(41.8)Z=-10.935<0.001
初中71(18.8)141(37.3)
高中/中专/技校89(23.5)44(11.6)
专科/本科及以上146(38.6)35(9.3)
职业公务员、事业单位人员、国企职工64(16.9)22(5.8)χ2=167.914<0.001
公司职员(私企或外企)46(12.2)11(2.9)
服务业人员2(0.5)6(1.6)
农民、渔民、牧民等26(6.9)159(42.1)
工人(包括农民工)19(5.0)41(10.8)
自由职业、个体户67(17.7)44(11.6)
离退休人员121(32.0)68(18.0)
其他33(8.7)27(7.1)
体质指数<18.5 kg/m227(7.1)39(10.3)Z=-1.5020.133
18.5~<24.0 kg/m2218(57.7)225(59.5)
24.0~<28.0 kg/m2116(30.7)87(23.0)
≥28.0 kg/m217(4.5)27(7.1)
腰高比<0.5293(77.5)226(59.8)χ2=27.590<0.001
≥0.585(22.5)152(40.2)
饮食结构素食为主21(5.6)33(8.7)
荤素搭配328(86.8)269(71.2)Z=29.536<0.001
肉食为主29(7.7)76(20.1)
蔬菜摄入情况无41(10.8)74(19.6)Z=-2.7430.006
1~3次/周214(56.6)204(54.0)
4~6次/周99(26.2)70(18.5)
>6次/周24(6.3)30(7.9)
水果摄入情况无30(7.9)90(23.8)Z=-10.924<0.001
1~3次/周102(27.0)187(49.5)
4~6次/周184(48.7)90(23.8)
>6次/周62(16.4)11(2.9)
红肉摄入情况无3(0.8)2(0.5)Z=-0.5380.590
1~3次/周68(18.0)67(17.7)
4~6次/周165(43.7)159(42.1)
>6次/周142(37.6)150(39.7)
白肉摄入情况无58(15.3)117(31.0)Z=-9.750<0.001
1~3次/周162(42.9)228(60.3)
4~6次/周121(32.0)30(7.9)
>6次/周37(9.8)3(0.8)
加工肉摄入情况无129(34.1)219(57.9)
1~3次/周139(36.8)146(38.6)Z=-8.748<0.001
≥4次/周110(29.1)13(3.4)
粗粮摄入情况无74(19.6)135(35.7)Z=-6.399<0.001
1~3次/周156(41.3)166(43.9)
4~6次/周107(28.3)60(15.9)
>6次/周41(10.8)17(4.5)
腌晒食品摄入情况无87(23.0)129(34.1)
1~3次/周143(37.8)129(34.1)Z=-3.1520.002
≥4次/周148(39.2)120(31.7)
饮食冷热度烫37(9.8)81(21.4)
适中300(79.4)280(74.1)Z=-5.195<0.001
凉41(10.8)17(4.5)
饮食干稀度干58(15.3)98(25.9)
适中218(57.7)180(47.6)Z=-2.1400.032
稀102(27.0)100(26.5)
饮食口味咸68(18.0)138(36.5)
适中194(51.3)164(43.4)Z=-5.529<0.001
清淡116(30.7)76(20.1)
饮食油脂情况重油85(22.5)127(33.6)
适中196(51.9)180(47.6)Z=-3.521<0.001
少油97(25.7)71(18.8)
饮食辣味特辣14(3.7)27(7.1)Z=-0.6510.515
中辣128(33.9)112(29.6)
微辣150(39.7)133(35.2)
不辣86(22.8)106(28.0)
饮食麻味特麻14(3.7)16(4.2)Z=-0.5490.583
中麻86(22.8)97(25.7)
微麻159(42.1)145(38.4)
不麻119(31.5)120(31.7)
进食速度<10 min43(11.4)103(27.2)Z=-4.541<0.001
10~15 min137(36.2)135(35.7)
>15~20 min159(42.1)91(24.1)
>20 min39(10.3)49(13.0)
吸烟情况从不271(71.7)155(41.0)
吸烟75(19.8)44(11.6)Z=-10.432<0.001
已戒烟32(8.5)179(47.4)
二手烟情况无240(63.5)158(41.8)Z=35.677<0.001
有138(36.5)220(58.2)
饮酒情况从不240(63.5)182(48.1)
饮酒96(25.4)32(8.5)Z=-6.759<0.001
已戒酒42(11.1)164(43.4)
每日饮水量<500 mL85(22.5)109(28.8)Z=-1.4100.158
500~1 000 mL169(44.7)111(29.4)
>1 000~1 500 mL92(24.3)83(22.0)
>1 500 mL32(8.5)75(19.8)
饮茶情况从不89(23.5)141(37.3)
偶尔167(44.2)153(40.5)Z=-4.323<0.001
经常122(32.3)84(22.2)
饮咖啡情况从不273(72.2)334(88.4)
偶尔98(25.9)43(11.4)Z=-5.616<0.001
经常7(1.9)1(0.3)
早餐情况无9(2.4)13(3.4)Z=-8.209<0.001
1~3次/周83(22.0)24(6.3)
4~6次/周91(24.1)34(9.0)
>6次/周195(51.6)307(81.2)
用餐规律总是规律148(39.2)171(45.2)
比较规律195(51.6)140(37.0)Z=-0.0960.923
不规律35(9.3)67(17.7)
运动锻炼从不锻炼68(18.0)45(11.9)
偶尔锻炼195(51.6)164(43.4)Z=-4.150<0.001
经常锻炼115(30.4)169(44.7)
熬夜基本不307(81.2)292(77.2)Z=1.8090.179
熬夜71(18.8)86(22.8)
幽门螺杆菌感染否320(84.7)319(84.4)
是,未治愈17(4.5)31(8.2)Z=6.5340.038
是,已治愈41(10.8)28(7.4)
反流性食管炎疾病史无375(99.2)372(98.4)χ2=1.0310.310
有3(0.8)6(1.6)
浅表性胃炎疾病史无354(93.7)316(83.6)χ2=18.946<0.001
有24(6.3)62(16.4)
萎缩性胃炎疾病史无371(98.1)346(91.5)χ2=16.897<0.001
有7(1.9)32(8.5)
胃溃疡疾病史无362(95.8)325(86.0)χ2=21.833<0.001
有16(4.2)53(14.0)
高血压无283(74.9)326(86.2)χ2=15.614<0.001
有95(25.1)52(13.8)
高血脂无343(90.7)370(97.9)χ2=17.976<0.001
有35(9.3)8(2.1)
糖尿病无340(89.9)350(92.6)χ2=1.6600.198
有38(10.1)28(7.4)
癌症家族史无323(85.4)262(69.3)χ2=28.121<0.001
有55(14.6)116(30.7)
精神创伤无362(95.8)344(91.0)χ2=6.9390.008
有16(4.2)34(9.0)
精神压抑无364(96.3)358(94.7)χ2=1.1090.292
有14(3.7)20(5.3)
性格A型120(31.7)214(56.6)
B型196(51.9)120(31.7)χ2=47.790<0.001
C型62(16.4)44(11.6)
), ArticleFig(id=1322530776881676793, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168642620477584, language=CN, label=表1, caption=

胃癌发病影响因素的单因素分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类对照组(n=378)病例组(n=378)统计值P
年龄40~<50岁48(12.7)53(14.0)Z=-0.8900.373
50~<60岁143(37.8)143(37.8)
60~<70岁121(32.0)131(34.7)
≥70岁66(17.5)51(13.5)
性别男245(64.8)265(70.1)χ2=2.4100.121
女133(35.2)113(29.9)
民族汉族356(94.2)353(93.4)χ2=0.2040.651
其他22(5.8)25(6.6)
婚姻状况已婚348(92.1)347(91.8)χ2=0.0180.894
其他30(7.9)31(8.2)
文化程度小学及以下72(19.0)158(41.8)Z=-10.935<0.001
初中71(18.8)141(37.3)
高中/中专/技校89(23.5)44(11.6)
专科/本科及以上146(38.6)35(9.3)
职业公务员、事业单位人员、国企职工64(16.9)22(5.8)χ2=167.914<0.001
公司职员(私企或外企)46(12.2)11(2.9)
服务业人员2(0.5)6(1.6)
农民、渔民、牧民等26(6.9)159(42.1)
工人(包括农民工)19(5.0)41(10.8)
自由职业、个体户67(17.7)44(11.6)
离退休人员121(32.0)68(18.0)
其他33(8.7)27(7.1)
体质指数<18.5 kg/m227(7.1)39(10.3)Z=-1.5020.133
18.5~<24.0 kg/m2218(57.7)225(59.5)
24.0~<28.0 kg/m2116(30.7)87(23.0)
≥28.0 kg/m217(4.5)27(7.1)
腰高比<0.5293(77.5)226(59.8)χ2=27.590<0.001
≥0.585(22.5)152(40.2)
饮食结构素食为主21(5.6)33(8.7)
荤素搭配328(86.8)269(71.2)Z=29.536<0.001
肉食为主29(7.7)76(20.1)
蔬菜摄入情况无41(10.8)74(19.6)Z=-2.7430.006
1~3次/周214(56.6)204(54.0)
4~6次/周99(26.2)70(18.5)
>6次/周24(6.3)30(7.9)
水果摄入情况无30(7.9)90(23.8)Z=-10.924<0.001
1~3次/周102(27.0)187(49.5)
4~6次/周184(48.7)90(23.8)
>6次/周62(16.4)11(2.9)
红肉摄入情况无3(0.8)2(0.5)Z=-0.5380.590
1~3次/周68(18.0)67(17.7)
4~6次/周165(43.7)159(42.1)
>6次/周142(37.6)150(39.7)
白肉摄入情况无58(15.3)117(31.0)Z=-9.750<0.001
1~3次/周162(42.9)228(60.3)
4~6次/周121(32.0)30(7.9)
>6次/周37(9.8)3(0.8)
加工肉摄入情况无129(34.1)219(57.9)
1~3次/周139(36.8)146(38.6)Z=-8.748<0.001
≥4次/周110(29.1)13(3.4)
粗粮摄入情况无74(19.6)135(35.7)Z=-6.399<0.001
1~3次/周156(41.3)166(43.9)
4~6次/周107(28.3)60(15.9)
>6次/周41(10.8)17(4.5)
腌晒食品摄入情况无87(23.0)129(34.1)
1~3次/周143(37.8)129(34.1)Z=-3.1520.002
≥4次/周148(39.2)120(31.7)
饮食冷热度烫37(9.8)81(21.4)
适中300(79.4)280(74.1)Z=-5.195<0.001
凉41(10.8)17(4.5)
饮食干稀度干58(15.3)98(25.9)
适中218(57.7)180(47.6)Z=-2.1400.032
稀102(27.0)100(26.5)
饮食口味咸68(18.0)138(36.5)
适中194(51.3)164(43.4)Z=-5.529<0.001
清淡116(30.7)76(20.1)
饮食油脂情况重油85(22.5)127(33.6)
适中196(51.9)180(47.6)Z=-3.521<0.001
少油97(25.7)71(18.8)
饮食辣味特辣14(3.7)27(7.1)Z=-0.6510.515
中辣128(33.9)112(29.6)
微辣150(39.7)133(35.2)
不辣86(22.8)106(28.0)
饮食麻味特麻14(3.7)16(4.2)Z=-0.5490.583
中麻86(22.8)97(25.7)
微麻159(42.1)145(38.4)
不麻119(31.5)120(31.7)
进食速度<10 min43(11.4)103(27.2)Z=-4.541<0.001
10~15 min137(36.2)135(35.7)
>15~20 min159(42.1)91(24.1)
>20 min39(10.3)49(13.0)
吸烟情况从不271(71.7)155(41.0)
吸烟75(19.8)44(11.6)Z=-10.432<0.001
已戒烟32(8.5)179(47.4)
二手烟情况无240(63.5)158(41.8)Z=35.677<0.001
有138(36.5)220(58.2)
饮酒情况从不240(63.5)182(48.1)
饮酒96(25.4)32(8.5)Z=-6.759<0.001
已戒酒42(11.1)164(43.4)
每日饮水量<500 mL85(22.5)109(28.8)Z=-1.4100.158
500~1 000 mL169(44.7)111(29.4)
>1 000~1 500 mL92(24.3)83(22.0)
>1 500 mL32(8.5)75(19.8)
饮茶情况从不89(23.5)141(37.3)
偶尔167(44.2)153(40.5)Z=-4.323<0.001
经常122(32.3)84(22.2)
饮咖啡情况从不273(72.2)334(88.4)
偶尔98(25.9)43(11.4)Z=-5.616<0.001
经常7(1.9)1(0.3)
早餐情况无9(2.4)13(3.4)Z=-8.209<0.001
1~3次/周83(22.0)24(6.3)
4~6次/周91(24.1)34(9.0)
>6次/周195(51.6)307(81.2)
用餐规律总是规律148(39.2)171(45.2)
比较规律195(51.6)140(37.0)Z=-0.0960.923
不规律35(9.3)67(17.7)
运动锻炼从不锻炼68(18.0)45(11.9)
偶尔锻炼195(51.6)164(43.4)Z=-4.150<0.001
经常锻炼115(30.4)169(44.7)
熬夜基本不307(81.2)292(77.2)Z=1.8090.179
熬夜71(18.8)86(22.8)
幽门螺杆菌感染否320(84.7)319(84.4)
是,未治愈17(4.5)31(8.2)Z=6.5340.038
是,已治愈41(10.8)28(7.4)
反流性食管炎疾病史无375(99.2)372(98.4)χ2=1.0310.310
有3(0.8)6(1.6)
浅表性胃炎疾病史无354(93.7)316(83.6)χ2=18.946<0.001
有24(6.3)62(16.4)
萎缩性胃炎疾病史无371(98.1)346(91.5)χ2=16.897<0.001
有7(1.9)32(8.5)
胃溃疡疾病史无362(95.8)325(86.0)χ2=21.833<0.001
有16(4.2)53(14.0)
高血压无283(74.9)326(86.2)χ2=15.614<0.001
有95(25.1)52(13.8)
高血脂无343(90.7)370(97.9)χ2=17.976<0.001
有35(9.3)8(2.1)
糖尿病无340(89.9)350(92.6)χ2=1.6600.198
有38(10.1)28(7.4)
癌症家族史无323(85.4)262(69.3)χ2=28.121<0.001
有55(14.6)116(30.7)
精神创伤无362(95.8)344(91.0)χ2=6.9390.008
有16(4.2)34(9.0)
精神压抑无364(96.3)358(94.7)χ2=1.1090.292
有14(3.7)20(5.3)
性格A型120(31.7)214(56.6)
B型196(51.9)120(31.7)χ2=47.790<0.001
C型62(16.4)44(11.6)
), ArticleFig(id=1322530776973951482, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168642620477584, language=EN, label=Table 2, caption=

Variable assignment status

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值方式
文化程度小学及以下=(0,0,0),初中=(1,0,0),高中/中专/技校=(0,1,0),专科/本科及以上=(0,0,1)
职业公务员、事业单位人员、国企职工=(0,0,0,0,0,0,0),公司职员(私企或外企)=(1,0,0,0,0,0,0),服务业人员=(0,1,0,0,0,0,0),农民、渔民、牧民等=(0,0,1,0,0,0,0),工人(包括农民工)=(0,0,0,1,0,0,0),自由职业、个体户=(0,0,0,0,1,0,0),离退休人员=(0,0,0,0,0,1,0),其他=(0,0,0,0,0,0,1)
腰高比<0.5=0,≥0.5=1
饮食结构素食为主=(0,0),荤素搭配=(1,0),肉食为主=(0,1)
蔬菜摄入情况无=(0,0,0),1~3次/周=(1,0,0),4~6次/周=(0,1,0),>6次/周=(0,0,1)
水果摄入情况无=(0,0,0),1~3次/周=(1,0,0),4~6次/周=(0,1,0),>6次/周=(0,0,1)
白肉摄入情况无=(0,0,0),1~3次/周=(1,0,0),4~6次/周=(0,1,0),>6次/周=(0,0,1)
加工肉摄入情况无=(0,0),1~3次/周=(1,0),≥4次/周=(0,1)
粗粮摄入情况无=(0,0,0),1~3次/周=(1,0,0),4~6次/周=(0,1,0),>6次/周=(0,0,1)
腌晒食品摄入情况无=(0,0),1~3次/周=(1,0),≥4次/周=(0,1)
饮食冷热度烫=(0,0),适中=(1,0),凉=(0,1)
饮食干稀度干=(0,0),适中=(1,0),稀=(0,1)
饮食口味咸=(0,0),适中=(1,0),清淡=(0,1)
饮食油脂情况重油=(0,0),适中=(1,0),少油=(0,1)
进食速度<10 min=(0,0,0),10~15 min=(1,0,0),>15~20 min=(0,1,0),>20 min=(0,0,1)
吸烟情况从不=(0,0),吸烟=(1,0),已戒烟=(0,1)
二手烟情况无=0,有=1
饮酒情况从不=(0,0),饮酒=(1,0),已戒酒=(0,1)
饮茶情况从不=(0,0),偶尔=(1,0),经常=(0,1)
饮咖啡情况从不=(0,0),偶尔=(1,0),经常=(0,1)
早餐情况无=(0,0,0),1~3次/周=(1,0,0),4~6次/周=(0,1,0),>6次/周=(0,0,1)
运动锻炼从不锻炼=(0,0),偶尔锻炼=(1,0),经常锻炼=(0,1)
幽门螺杆菌感染否=(0,0),是,未治愈=(1,0),是,已治愈=(0,1)
浅表性胃炎疾病史无=0,有=1
萎缩性胃炎疾病史无=0,有=1
胃溃疡疾病史无=0,有=1
高血压无=0,有=1
高血脂无=0,有=1
癌症家族史无=0,有=1
精神创伤无=0,有=1
性格A型=(0,0),B型=(1,0),C型=(0,1)
胃癌否=0,是=1
), ArticleFig(id=1322530777057837563, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168642620477584, language=CN, label=表2, caption=

变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值方式
文化程度小学及以下=(0,0,0),初中=(1,0,0),高中/中专/技校=(0,1,0),专科/本科及以上=(0,0,1)
职业公务员、事业单位人员、国企职工=(0,0,0,0,0,0,0),公司职员(私企或外企)=(1,0,0,0,0,0,0),服务业人员=(0,1,0,0,0,0,0),农民、渔民、牧民等=(0,0,1,0,0,0,0),工人(包括农民工)=(0,0,0,1,0,0,0),自由职业、个体户=(0,0,0,0,1,0,0),离退休人员=(0,0,0,0,0,1,0),其他=(0,0,0,0,0,0,1)
腰高比<0.5=0,≥0.5=1
饮食结构素食为主=(0,0),荤素搭配=(1,0),肉食为主=(0,1)
蔬菜摄入情况无=(0,0,0),1~3次/周=(1,0,0),4~6次/周=(0,1,0),>6次/周=(0,0,1)
水果摄入情况无=(0,0,0),1~3次/周=(1,0,0),4~6次/周=(0,1,0),>6次/周=(0,0,1)
白肉摄入情况无=(0,0,0),1~3次/周=(1,0,0),4~6次/周=(0,1,0),>6次/周=(0,0,1)
加工肉摄入情况无=(0,0),1~3次/周=(1,0),≥4次/周=(0,1)
粗粮摄入情况无=(0,0,0),1~3次/周=(1,0,0),4~6次/周=(0,1,0),>6次/周=(0,0,1)
腌晒食品摄入情况无=(0,0),1~3次/周=(1,0),≥4次/周=(0,1)
饮食冷热度烫=(0,0),适中=(1,0),凉=(0,1)
饮食干稀度干=(0,0),适中=(1,0),稀=(0,1)
饮食口味咸=(0,0),适中=(1,0),清淡=(0,1)
饮食油脂情况重油=(0,0),适中=(1,0),少油=(0,1)
进食速度<10 min=(0,0,0),10~15 min=(1,0,0),>15~20 min=(0,1,0),>20 min=(0,0,1)
吸烟情况从不=(0,0),吸烟=(1,0),已戒烟=(0,1)
二手烟情况无=0,有=1
饮酒情况从不=(0,0),饮酒=(1,0),已戒酒=(0,1)
饮茶情况从不=(0,0),偶尔=(1,0),经常=(0,1)
饮咖啡情况从不=(0,0),偶尔=(1,0),经常=(0,1)
早餐情况无=(0,0,0),1~3次/周=(1,0,0),4~6次/周=(0,1,0),>6次/周=(0,0,1)
运动锻炼从不锻炼=(0,0),偶尔锻炼=(1,0),经常锻炼=(0,1)
幽门螺杆菌感染否=(0,0),是,未治愈=(1,0),是,已治愈=(0,1)
浅表性胃炎疾病史无=0,有=1
萎缩性胃炎疾病史无=0,有=1
胃溃疡疾病史无=0,有=1
高血压无=0,有=1
高血脂无=0,有=1
癌症家族史无=0,有=1
精神创伤无=0,有=1
性格A型=(0,0),B型=(1,0),C型=(0,1)
胃癌否=0,是=1
), ArticleFig(id=1322530777120752124, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168642620477584, language=EN, label=Table 3, caption=

Multivariate logistic regression analysis results of influencing factors of gastric cancer

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分类回归系数标准误Wald χ2值POR值95%CI
文化程度小学及以下1.000
初中0.2410.3530.4680.4941.273[0.638,2.542]
高中/中专/技校-0.3440.4570.5670.4510.709[0.290,1.735]
专科/本科及以上-1.1680.4656.3140.0120.311[0.125,0.774]
职业公务员、事业单位人员、国企职工1.000
公司职员(私企或外企)-0.5650.6460.7650.3820.569[0.160,2.015]
服务业人员2.0821.5681.7620.1848.020[0.371,173.482]
农民、渔民、牧民等1.5790.5947.0750.0084.849[1.515,15.520]
工人(包括农民工)0.5650.6630.7260.3941.759[0.480,6.444]
自由职业、个体户0.1440.5490.0680.7941.154[0.393,3.388]
离退休人员-0.4500.4830.8670.3520.638[0.247,1.644]
其他-0.6510.5921.2100.2710.522[0.163,1.664]
白肉摄入情况无1.000
1~3次/周0.4300.3501.5110.2191.537[0.774,3.052]
4~6次/周0.3830.4560.7050.4010.682[0.279,1.666]
>6次/周-1.5551.0042.3980.1210.211[0.029,1.511]
加工肉摄入情况无1.000
1~3次/周0.2050.3110.4350.5101.227[0.668,2.256]
≥4次/周-2.1240.57913.470<0.0010.120[0.038,0.372]
粗粮摄入情况无1.000
1~3次/周-0.8360.3176.9530.0080.433[0.233,0.807]
4~6次/周-0.9470.3905.8970.0150.388[0.181,0.833]
>6次/周-2.5740.58119.652<0.0010.076[0.024,0.238]
腌晒食品摄入情况无1.000
1~3次/周-0.1300.3300.1540.6940.878[0.460,1.676]
≥4次/周-0.4740.3481.8490.1740.623[0.315,1.233]
饮食冷热度烫1.000
适中-0.2510.3640.4750.4910.778[0.381,1.588]
凉-2.1130.62211.555<0.0010.121[0.036,0.409]
饮食口味咸1.000
适中-1.2950.32915.457<0.0010.274[0.144,0.522]
清淡-1.3090.38511.5370.0010.270[0.127,0.575]
早餐情况无1.000
1~3次/周-1.0250.8941.3130.2520.359[0.062,2.071]
4~6次/周-0.7750.8860.7650.3820.461[0.081,2.617]
>6次/周0.3670.8180.2020.6531.444[0.291,7.169]
进食速度<10 min1.000
10~15 min-0.7620.3794.0460.0440.467[0.222,0.981]
15~20 min-1.2060.4048.9070.0030.299[0.136,0.661]
>20 min-0.4590.4870.8880.3460.632[0.243,1.641]
吸烟情况从不吸1.000
吸烟0.3780.4280.7790.3771.460[0.630,3.380]
已戒烟1.7590.40319.065<0.0015.808[2.637,12.792]
饮酒情况从不1.000
饮酒-0.9880.4484.8690.0270.372[0.155,0.895]
已戒酒1.2100.3919.5510.0023.352[1.557,7.219]
饮茶情况从不1.000
偶尔0.1550.3310.2210.6381.168[0.611,2.234]
经常-1.1850.3769.9330.0020.306[0.146,0.639]
浅表性胃炎疾病史无1.000
有1.0730.4096.8940.0092.925[1.313,6.517]
萎缩性胃炎疾病史无1.000
有1.6600.6985.6470.0175.257[1.337,20.663]
胃溃疡疾病史无1.000
有1.6480.48611.5210.0015.198[2.007,13.463]
高血压无1.000
有-1.2260.33813.134<0.0010.293[0.151,0.570]
高血脂无1.000
有-1.4130.6484.7540.0290.243[0.068,0.867]
癌症家族史无1.000
有0.7680.3086.2300.0132.156[1.179,3.943]
性格A型1.000
B型-0.9540.28411.2730.0010.385[0.221,0.672]
C型-0.9060.4055.0150.0250.404[0.183,0.893]
), ArticleFig(id=1322530777200443901, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168642620477584, language=CN, label=表3, caption=

胃癌发病影响因素的多因素Logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分类回归系数标准误Wald χ2值POR值95%CI
文化程度小学及以下1.000
初中0.2410.3530.4680.4941.273[0.638,2.542]
高中/中专/技校-0.3440.4570.5670.4510.709[0.290,1.735]
专科/本科及以上-1.1680.4656.3140.0120.311[0.125,0.774]
职业公务员、事业单位人员、国企职工1.000
公司职员(私企或外企)-0.5650.6460.7650.3820.569[0.160,2.015]
服务业人员2.0821.5681.7620.1848.020[0.371,173.482]
农民、渔民、牧民等1.5790.5947.0750.0084.849[1.515,15.520]
工人(包括农民工)0.5650.6630.7260.3941.759[0.480,6.444]
自由职业、个体户0.1440.5490.0680.7941.154[0.393,3.388]
离退休人员-0.4500.4830.8670.3520.638[0.247,1.644]
其他-0.6510.5921.2100.2710.522[0.163,1.664]
白肉摄入情况无1.000
1~3次/周0.4300.3501.5110.2191.537[0.774,3.052]
4~6次/周0.3830.4560.7050.4010.682[0.279,1.666]
>6次/周-1.5551.0042.3980.1210.211[0.029,1.511]
加工肉摄入情况无1.000
1~3次/周0.2050.3110.4350.5101.227[0.668,2.256]
≥4次/周-2.1240.57913.470<0.0010.120[0.038,0.372]
粗粮摄入情况无1.000
1~3次/周-0.8360.3176.9530.0080.433[0.233,0.807]
4~6次/周-0.9470.3905.8970.0150.388[0.181,0.833]
>6次/周-2.5740.58119.652<0.0010.076[0.024,0.238]
腌晒食品摄入情况无1.000
1~3次/周-0.1300.3300.1540.6940.878[0.460,1.676]
≥4次/周-0.4740.3481.8490.1740.623[0.315,1.233]
饮食冷热度烫1.000
适中-0.2510.3640.4750.4910.778[0.381,1.588]
凉-2.1130.62211.555<0.0010.121[0.036,0.409]
饮食口味咸1.000
适中-1.2950.32915.457<0.0010.274[0.144,0.522]
清淡-1.3090.38511.5370.0010.270[0.127,0.575]
早餐情况无1.000
1~3次/周-1.0250.8941.3130.2520.359[0.062,2.071]
4~6次/周-0.7750.8860.7650.3820.461[0.081,2.617]
>6次/周0.3670.8180.2020.6531.444[0.291,7.169]
进食速度<10 min1.000
10~15 min-0.7620.3794.0460.0440.467[0.222,0.981]
15~20 min-1.2060.4048.9070.0030.299[0.136,0.661]
>20 min-0.4590.4870.8880.3460.632[0.243,1.641]
吸烟情况从不吸1.000
吸烟0.3780.4280.7790.3771.460[0.630,3.380]
已戒烟1.7590.40319.065<0.0015.808[2.637,12.792]
饮酒情况从不1.000
饮酒-0.9880.4484.8690.0270.372[0.155,0.895]
已戒酒1.2100.3919.5510.0023.352[1.557,7.219]
饮茶情况从不1.000
偶尔0.1550.3310.2210.6381.168[0.611,2.234]
经常-1.1850.3769.9330.0020.306[0.146,0.639]
浅表性胃炎疾病史无1.000
有1.0730.4096.8940.0092.925[1.313,6.517]
萎缩性胃炎疾病史无1.000
有1.6600.6985.6470.0175.257[1.337,20.663]
胃溃疡疾病史无1.000
有1.6480.48611.5210.0015.198[2.007,13.463]
高血压无1.000
有-1.2260.33813.134<0.0010.293[0.151,0.570]
高血脂无1.000
有-1.4130.6484.7540.0290.243[0.068,0.867]
癌症家族史无1.000
有0.7680.3086.2300.0132.156[1.179,3.943]
性格A型1.000
B型-0.9540.28411.2730.0010.385[0.221,0.672]
C型-0.9060.4055.0150.0250.404[0.183,0.893]
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基于随机森林构建胃癌风险预测模型
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王青青 1 , 武文博 1, *, * , 万绍平 1 , 张铃林 2 , 李玉婷 3 , 容丽楼 1
护理研究 | 科研论著 2026,40(7): 1070-1080
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护理研究 |科研论著 2026 , 40 (7) : 1070 -1080
基于随机森林构建胃癌风险预测模型
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王青青1, 武文博1, *, * , 万绍平1, 张铃林2, 李玉婷3, 容丽楼1
作者信息
  • 1四川省肿瘤医院,四川省肿瘤研究所,电子科技大学附属肿瘤医院,四川 610041
  • 2仁寿县疾病 预防控制中心
  • 3四川省精神卫生中心(绵阳市第三人民医院)
通讯作者:
武文博,E-mail:
WU Wenbo, E-mail:
作者简介:

王青青,主管技师,硕士研究生

Construction of a risk prediction model for gastric cancer based on random forest
Qingqing WANG1, Wenbo WU1 , Shaoping WAN1, Linglin ZHANG2, Yuting LI3, Lilou RONG1
Affiliations
  • 1Sichuan Cancer Hospital, Sichuan Cancer Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Sichuan 610041 China
  • 2Renshou County Center for Disease Control and Prevention
  • 3Sichuan Provincial Mental Health Center(Mianyang Third People's Hospital)
  • Corresponding Author:
    WU Wenbo, E-mail:
出版时间: 2026-04-10 doi: 10.12102/j.issn.1009-6493.2026.07.002
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目的

构建四川省胃癌风险预测模型并识别预测因子。

方法

选取2021年7月—2022年8月四川省4所医疗机构确诊为胃癌的378例病人为病例组,选取同期体检的378名健康者为对照组,采用随机森林法构建胃癌风险预测模型,采用准确率、灵敏度、特异度、受试者工作特征(ROC)曲线下面积(AUC)、校准曲线、决策曲线(DCA)评价模型性能。

结果

文化程度、职业、白肉摄入量、加工肉摄入量、粗粮摄入量、腌晒食品摄入量、饮食口味、饮食冷热度、进食速度、早餐情况、吸烟情况、饮酒情况、饮茶情况、浅表性胃炎疾病史、萎缩性胃炎疾病史、胃溃疡疾病史、高血压、高血脂、癌症家族史、性格是胃癌的独立影响因素。影响因素重要性评分前3位为:职业、文化程度、吸烟情况。预测模型的准确率为99.8%,灵敏度为100.0%,特异度为99.6%,AUC值为0.999[95%CI(0.998,1.000)]。预测模型校准曲线提示模型与实际观测结果存在较好的一致性;DCA曲线提示该模型预测胃癌具备良好的临床效用。

结论

基于随机森林法构建的四川省胃癌风险预测模型具有较好的预测效能,有助于早期识别胃癌高危人群。

胃癌  /  随机森林  /  风险预测模型  /  影响因素
Objective

To construct a risk prediction model for gastric cancer in Sichuan province and to identify its predictive factors.

Methods

A total of 378 patients diagnosed with gastric cancer in four medical institutions in Sichuan province from July 2021 to August 2022 were selected as the case group.A total of 378 healthy individuals undergoing physical examinations during the same period were selected as the control group.The random forest method was used to construct a risk prediction model for gastric cancer.The performance of the model was evaluated by using accuracy,sensitivity,specificity,area under the ROC curve(AUC),calibration curve,and decision curve analysis(DCA).

Results

Educational level,occupation,white meat intake,processed meat intake,coarse grain intake,pickled and sun dried food intake,dietary taste,dietary coldness and heat,eating speed,breakfast status,smoking status,alcohol consumption,tea drinking status,history of superficial gastritis,atrophic gastritis,gastric ulcer,hypertension,hyperlipidemia,family history of cancer,and personality were independent influencing factors for gastric cancer.The top three influencing factors in terms of importance score were occupation,education level,and smoking status.The accuracy of the prediction model was 99.8%.The sensitivity was 100.0%.The specificity was 99.6%.The AUC was 0.999(95%CI 0.998-1.000).The calibration curve of the prediction model indicated good consistency between the model and the actual observation results.The DCA curve suggested that the model has good clinical efficacy in predicting gastric cancer.

Conclusions

The risk prediction model for gastric cancer of Sichuan province constructed based on the random forest method in this study has good predictive performance and is helpful for early identification of high-risk population for gastric cancer.

gastric cancer  /  random forest  /  risk prediction model  /  influencing factors
王青青, 武文博, 万绍平, 张铃林, 李玉婷, 容丽楼. 基于随机森林构建胃癌风险预测模型. 护理研究, 2026 , 40 (7) : 1070 -1080 . DOI: 10.12102/j.issn.1009-6493.2026.07.002
Qingqing WANG, Wenbo WU, Shaoping WAN, Linglin ZHANG, Yuting LI, Lilou RONG. Construction of a risk prediction model for gastric cancer based on random forest[J]. Chinese Nursing Research, 2026 , 40 (7) : 1070 -1080 . DOI: 10.12102/j.issn.1009-6493.2026.07.002
2022年,我国胃癌新发病例数35.8万例,死亡26.0万例,占全球胃癌新发病例的37.0%,占全球死亡病例的39.4%[1],均处于较高水平。2019年,四川省胃癌发病率为11.12/10万,死亡率为8.63/10万,发病率居四川省第7位,死亡率居四川省第4位[2],是威胁我省居民健康的主要恶性肿瘤之一。胃癌的早期诊断和治疗对于提高病人生存率、降低死亡率至关重要,筛查是早期发现胃癌的重要手段。当前,我国胃癌主要依赖内镜筛查[3],由于其侵入性和高成本,难以在较大范围内,特别是农村和偏远地区推广。为此,亟须研发一种高效、简便,同时成本较低的发现胃癌高危人群的方法。机器学习技术是用于开发预测和数据分析模型的工具,可从大量、高维数据中提取隐藏关系[4-5],捕获数据中的多方面非线性关系,以提高预测精度[6-7]。目前,国内外已有一些研究尝试利用机器学习技术构建胃癌发病风险预测模型,如刘福志等[8-11]构建的模型。由于不同地域、饮食和生活习惯等因素的影响,胃癌的发病因素可能存在显著的地区差异。四川省具有独特的地域、饮食和生活习惯,构建适用于本地的胃癌发病风险预测模型具有重要意义。本研究旨在通过机器学习的方法,结合四川省居民胃癌发病的密切相关因素,通过多因素分析构建四川省人群胃癌的筛查模型,对于提高胃癌的早期诊断率、优化医疗资源配置、指导社区开展健康教育和预防工作具有重要意义。
选取2021年7月—2022年8月四川省肿瘤医院、绵阳市中心医院、遂宁市中心医院、凉山州第一人民医院收治的胃癌病人为病例组。病例组纳入标准:1)经组织病理学检查诊断为原发性胃癌的病人;2)确诊时间<6个月;3)年龄≥40岁;4)四川省常住人口。病例组排除标准:1)胃癌复发或转移的病人;2)经诊断同时(或既往)合并其他肿瘤的病人;3)拒绝参与本研究或配合度较差者。选取同期于四川省肿瘤医院、绵阳市中心医院、遂宁市中心医院、凉山州第一人民医院体检的健康者为对照组。对照组纳入标准:1)经诊断未患胃癌的健康体检人群;2)年龄≥40岁;3)四川省常住人口。对照组排除标准:1)经诊断患其他肿瘤的病人;2)拒绝参与本研究或配合度较差者。本研究已经四川省肿瘤医院医学科研与医疗新技术伦理委员会审批(审批号:SCCHEC-02-2021-085),所有参与者均签署知情同意书。
在PubMed、中国知网、万方数据库等数据库中检索胃癌危险因素相关文献,筛选原发性胃癌危险因素,结合城市癌症早诊早治项目防癌风险评估问卷及专家意见,自行设计调查问卷,主要内容包括基本情况(性别、年龄、民族、身高、体重、腰围等)、饮食习惯(饮食结构、饮食摄入情况、饮食喜好等)、生活行为方式(吸烟、二手烟、饮酒、每日饮水量、喝茶等)、疾病史(幽门螺杆菌感染、胃部疾病、高血压、高血脂等)、肿瘤家族史、心理情绪(精神创伤、精神压抑、性格)。
通过序贯调查方式,将调查内容编制成电子问卷。病例组由调查员一对一、面对面询问后填写问卷,对照组中能熟练使用电子产品的调查对象扫描二维码自行填写,不能自行填写者由调查员一对一询问后填写问卷。
调查前,统一培训调查员,调查员考核通过后参与现场调查;电子问卷设置质控题和极值,保证无缺项。在调查过程中,每日核查问卷是否存在乱答、误答等问题,若存在异常数据,则向调查员核实后完善或删除该问卷。调查后,对问卷调查结果再次核实、剔除结果异常的数据。
采用倾向得分匹配法(propensity score matching,PSM),以是否患胃癌为因变量,年龄、性别、民族、婚姻状况为自变量,建立Logistic回归模型计算倾向得分,选用最邻近匹配法进行匹配,匹配标准为倾向得分的差值<0.05分。本研究共调查1 256人,其中病例组497例,对照组759人,经1∶1匹配后,病例组与对照组均纳入378例。
采用R 4.4.2软件进行数据统计分析。定性资料以例数、百分比(%)表示,以是否患胃癌为因变量,其他变量为自变量,采用χ2检验、非参数检验和二元Logistic回归分析筛选自变量。采用R软件中的caret软件包按照7∶3的比例将数据集划分为训练集(n=530)和验证集(n=226)。在训练集中,通过caret软件包进行10折交叉验证,对模型参数进行调整。使用Random Forest软件包建立随机森林模型,采用平均准确度降低(MDA)评价影响因素的重要性,其值越大,说明该影响因素越重要。对验证集,利用受试者工作特征(receiver operating characteristic curve,ROC)曲线下面积(area under curve,AUC)、校准曲线、决策曲线(decision curve analysis,DCA)评估预测模型的临床有效性。
病例组:年龄(60.21±9.57)岁;男265例(70.1%),女113例(29.9%)。对照组:年龄(60.41±9.52)岁;男245人(64.8%),女133人(35.2%)。两组性格、文化程度、职业、水果摄入情况、蔬菜摄入情况、白肉摄入情况、加工肉摄入情况、粗粮摄入情况、腰高比、精神创伤、癌症家族史、高血脂、高血压、胃溃疡疾病史、萎缩性胃炎疾病史、腌晒食品摄入情况、浅表性胃炎疾病史、幽门螺杆菌感染、运动锻炼、饮茶情况、饮咖啡情况、早餐情况、饮食冷热度、饮食结构、饮食干稀度、饮食口味、饮食油脂情况、进食速度、吸烟情况、二手烟情况、饮酒情况存在差异(P<0.05),详见表1。
以是否患胃癌为因变量,将单因素分析中P<0.05的变量(性格、文化程度、职业、水果摄入情况、蔬菜摄入情况、白肉摄入情况、加工肉摄入情况、粗粮摄入情况、腰高比、精神创伤、癌症家族史、高血脂、高血压、胃溃疡疾病史、萎缩性胃炎疾病史、腌晒食品摄入情况、浅表性胃炎疾病史、幽门螺杆菌感染、运动锻炼、饮茶情况、饮咖啡情况、早餐情况、饮食冷热度、饮食结构、饮食干稀度、饮食口味、饮食油脂情况、进食速度、吸烟情况、二手烟情况、饮酒情况)纳入Logistic回归分析,自变量赋值情况见表2,结果显示,文化程度、职业、加工肉摄入情况、粗粮摄入情况、饮食口味、饮食冷热度、进食速度、吸烟情况、饮酒情况、饮茶情况、浅表性胃炎疾病史、萎缩性胃炎疾病史、胃溃疡疾病史、高血压、高血脂、癌症家族史、性格是胃癌的独立影响因素(P<0.05)。因白肉摄入情况、早餐情况2个变量亚组例数小于30,考虑统计检验效能,予以纳入;且结合临床意义,纳入变量腌晒食品摄入情况。结果详见表3。
基于Logistic回归分析结果及临床经验构建胃癌发病风险随机森林模型,通过10折交叉验证对模型参数进行调整,评估不同参数设置下模型的泛化能力,最终得到最优参数:mtry=3,ntree=250。重要性评分排名前3位的影响因素由高到低依次为职业(19.67分)、文化程度(16.00分)、吸烟情况(14.92分)。详见图1。
结果显示,胃癌随机森林预测模型训练集准确率为99.8%,灵敏度为100.0%,特异度为99.6%;验证集准确率为86.3%,灵敏度为90.3%,特异度为82.3%。模型训练集的AUC值为0.999[95%CI(0.998,1.000)],验证集的AUC值为0.937[95%CI(0.906,0.968)],表明模型具有良好的分类性能,详见图2。
绘制胃癌风险校正曲线,结果表明拟合良好,模型预测结果与实际观测结果存在较好的一致性,详见图3。
结果显示,随机森林模型存在显著的正向净收益,此模型在预测胃癌发病风险方面具备良好的临床效用,详见图4。
随机森林作为一种成熟的机器学习算法,具有高效处理缺失值、将影响因素降维、不易过拟合等优点[12]。本研究综合文化程度、职业、白肉摄入情况、加工肉摄入情况、粗粮摄入情况、腌晒食品摄入情况、饮食口味、饮食冷热度、进食速度、早餐情况、吸烟情况、饮酒情况、饮茶情况、浅表性胃炎疾病史、萎缩性胃炎疾病史、胃溃疡疾病史、高血压、高血脂、癌症家族史、性格20个影响因素建立胃癌风险预测模型,利用重要性排序筛选出重要变量。本研究构建的胃癌发病风险预测模型AUC值为0.999,高于Cai等[13](AUC=0.757)、Iida等[14](AUC=0.760)、Eom等[15](男性AUC=0.764,女性AUC=0.706)等构建模型的AUC值,且高于刘福志[8]利用环境因素和遗传因素构建的Logistic、贝叶斯网络、支持向量机、决策树、随机森林模型,刘迷迷[16]构建的决策树、树扩展的朴贝叶斯网络、多层感知神经网络、支持向量机模型,以及杨荣等[17]构建的决策树模型,说明本研究构建的预测模型具备较好的区分能力。本研究构建的预测模型校准曲线与实际曲线拟合程度较好,决策曲线净收益率高,说明模型校准度好且具备一定临床适用性。
本研究将职业纳入胃癌发病风险预测模型,与刘迷迷等[16,18]研究结果一致。不同职业人群的饮食多样性、饮食规律性不同,如农民可能因忙于农活而频繁错过正常用餐时间,导致饮食不规律,进而增加了罹患胃溃疡、萎缩性胃炎等胃部疾病的风险,相关研究发现上消化道疾病与胃癌的发病风险密切相关[19]。
本研究发现,文化程度是预测胃癌发病的一个重要因素,尽管在以往的模型中鲜有提及,但有研究表明文化程度是胃癌发病的影响因素[20]。这可能是因为不同学历层次的人群在获取和理解胃癌防治知识的能力上存在差异,从而导致他们在胃癌防治意识上的高低不同,进而影响他们是否采取预防措施[21]。
研究表明,吸烟和饮酒是胃癌的危险因素[22-27]。本研究结果表明,吸烟、饮酒被纳入构建的风险预测模型中,与刘福志等[8,15,22-23]研究结果一致。
在饮食因素方面,本研究考虑了加工肉、腌晒食品、粗粮等与胃癌发病相关的因素,与刘福志[8]基于贝叶斯网络、逻辑判别、支持向量机、决策树和随机森林构建的模型纳入的影响因素相似。
本研究还纳入了胃部疾病史和癌症家族史作为预测变量,与刘迷迷等[16,18]研究结果一致。研究发现,有上消化道疾病史的人群患胃癌风险是普通人群4倍[28],人群归因危险度为65.87%[29]。
1)本研究为回顾性问卷调查,需调查对象回顾其既往的饮食习惯和生活方式,不可避免存在回忆偏倚;2)本研究构建的胃癌风险预测模型虽已进行内部验证,但仍需在未来的研究中进行外部验证,以进一步确认其准确性和可靠性。
综上所述,本研究通过综合考虑个人职业、文化程度、生活习惯(包括吸烟和饮酒)、饮食习惯以及疾病史和家族史等多个维度,构建了一个全面且高效的胃癌发病风险预测模型。该模型不仅具有无创、高效、简便和低成本的优点,且具有较高的准确性和可靠性,为胃癌的早期筛查和防治提供了有力的支持。

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doi: 10.12102/j.issn.1009-6493.2026.07.002
  • 接收时间:2025-01-23
  • 首发时间:2026-10-28
  • 出版时间:2026-04-10
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  • 收稿日期:2025-01-23
  • 修回日期:2026-01-07
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    1四川省肿瘤医院,四川省肿瘤研究所,电子科技大学附属肿瘤医院,四川 610041
    2仁寿县疾病 预防控制中心
    3四川省精神卫生中心(绵阳市第三人民医院)

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