Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 10, Number 2, April 2017, pages 120-125

The Diagnostic Value of Alarm Features for Identifying Types and Stages of Upper Gastrointestinal Malignancies

**Table 1.** The Basic Characteristics of Enrolled Individuals
	Upper GI endoscopy finding
^aKruskal-Wallis one-way ANOVA test. ^bPearson’s Chi-square test. Sixteen patients had more than one alarm features.
Age (years)	47.5 ± 15.7	54.6 ± 14.3	64.6 ± 13.5	50.3 ± 16.2	0.001^a
Gender
Male	1,134 (42.9%)	644 (53.6%)	58 (70.7%)	1,836 (46.8%)	0.001^b
Female	1,508 (57.1%)	558 (46.4%)	24 (29.3%)	2,090 (53.2%)
H. pylori infection
Positive	296 (17.1%)	522 (43.4%)	12 (17.1%)	421 (28.4%)	0.001^b
Excluded numbers	906	90	12
Alarm features
GI bleeding	49 (1.9%)	104 (8.7%)	20 (24.4%)	173 (4.4%)	0.001^b
Body weight loss	53 (2.0%)	38 (3.2%)	24 (29.3%)	115 (2.9%)	0.001^b
Dysphagia	4 (0.2%)	2 (0.2%)	12 (14.6%)	18 (0.5%)	0.001^b
At least one alarm feature	102 (3.9%)	138 (11.5%)	50 (60.1%)	290 (7.4%)	0.001^b

Table 1. The Basic Characteristics of Enrolled Individuals

Upper GI endoscopy finding

Normal (n = 2,642, 67.3%)

Gastroduodenitis/peptic ulcer disease (n = 1,202, 30.6%)

Upper GI malignancies (n = 82, 2.1%)

Total (n = 3,926)

P-value

^aKruskal-Wallis one-way ANOVA test. ^bPearson’s Chi-square test. Sixteen patients had more than one alarm features.

Age (years)

47.5 ± 15.7

54.6 ± 14.3

64.6 ± 13.5

50.3 ± 16.2

0.001^a

Gender

Male

1,134 (42.9%)

644 (53.6%)

58 (70.7%)

1,836 (46.8%)

0.001^b

Female

1,508 (57.1%)

558 (46.4%)

24 (29.3%)

2,090 (53.2%)

H. pylori infection

Positive

296 (17.1%)

522 (43.4%)

12 (17.1%)

421 (28.4%)

0.001^b

Excluded numbers

906

Alarm features

GI bleeding

49 (1.9%)

104 (8.7%)

20 (24.4%)

173 (4.4%)

0.001^b

Body weight loss

53 (2.0%)

38 (3.2%)

24 (29.3%)

115 (2.9%)

0.001^b

Dysphagia

4 (0.2%)

2 (0.2%)

12 (14.6%)

18 (0.5%)

0.001^b

At least one alarm feature

102 (3.9%)

138 (11.5%)

50 (60.1%)

290 (7.4%)

0.001^b

**Table 2.** The Associations of Alarm Features and Upper Gastrointestinal Malignancies
	Patients with alarm features	Patients with upper GI malignancies and alarm features	Patients without alarm features	Patients with upper GI malignancy but no alarm features	Sensitivity	Specificity	Positive predictive value	Negative predictive value
Sixteen patients had more than one alarm features.
Gastrointestinal bleeding	173	20	3,753	62	0.24	0.96	0.12	0.98
Body weight loss	115	24	3,811	58	0.29	0.98	0.21	0.98
Dysphagia	18	12	3,908	70	0.15	0.99	0.67	0.98
At least one alarm feature	290	50	3,636	32	0.61	0.94	0.17	0.99

Table 2. The Associations of Alarm Features and Upper Gastrointestinal Malignancies

Patients with alarm features

Patients with upper GI malignancies and alarm features

Patients without alarm features

Patients with upper GI malignancy but no alarm features

Sensitivity

Specificity

Positive predictive value

Negative predictive value

Sixteen patients had more than one alarm features.

Gastrointestinal bleeding

173

3,753

0.24

0.96

0.12

0.98

Body weight loss

115

3,811

0.29

0.98

0.21

0.98

Dysphagia

3,908

0.15

0.99

0.67

0.98

At least one alarm feature

290

3,636

0.61

0.94

0.17

0.99

**Table 3.** The Basic Characteristics of the Individuals With Upper Gastrointestinal Malignancies
	Upper GI malignancies
^aKruskal-Wallis one-way ANOVA test. ^bPearson’s Chi-square test. Upper gastric cancers is defined as cancers in the cardia, fundus or upper corpus; lower gastric cancers is defined as cancers in antrum or angularis. ^#P = 0.062 analyzed by Fisher’s exact test. Six patients had more than one alarm features.
Age (years)	63.14 ± 13.92	67.83 ± 13.89	63.19 ± 13.37	77.50 ± 5.20		0.122^a
Gender
Male	12 (85.7%)	10 (17.2%)	32 (61.5%)	4 (100%)	58 (70.7%)	0.102^b
Female	2 (8.3%)	2 (8.3%)	20 (38.5%)	0	24 (29.3%)
H. pylori infection
Positive	0	0^#	12 (23.1%)^#	0	12 (17.1%)	0.171^b
Excluded numbers	12	0	0	0
Alarm features
GI bleeding	1 (7.1%)	0	19 (36.5%)	0	18	0.008^b
Body weight loss	7 (50.0%)	6 (50.0%)	8 (15.4%)	2 (50.0%)	22	0.010^b
Dysphagia	7 (50.0%)	6 (50.0%)	0	0	10	0.001^b
At least one alarm feature	12 (85.7%)	10 (83.3%)	26 (50.0%)	2 (50.0%)	32	0.063^b

Table 3. The Basic Characteristics of the Individuals With Upper Gastrointestinal Malignancies

Upper GI malignancies

Esophageal cancers (n = 14, 17.1%)

Upper gastric cancers (n = 12, 14.6%)

Lower gastric cancers (n = 52, 63.4%)

Duodenal cancers (n = 4, 4.9%)

Total (n = 82)

P-value

^aKruskal-Wallis one-way ANOVA test. ^bPearson’s Chi-square test. Upper gastric cancers is defined as cancers in the cardia, fundus or upper corpus; lower gastric cancers is defined as cancers in antrum or angularis. ^#P = 0.062 analyzed by Fisher’s exact test. Six patients had more than one alarm features.

Age (years)

63.14 ± 13.92

67.83 ± 13.89

63.19 ± 13.37

77.50 ± 5.20

0.122^a

Gender

Male

12 (85.7%)

10 (17.2%)

32 (61.5%)

4 (100%)

58 (70.7%)

0.102^b

Female

2 (8.3%)

20 (38.5%)

24 (29.3%)

H. pylori infection

Positive

0^#

12 (23.1%)^#

12 (17.1%)

0.171^b

Excluded numbers

Alarm features

GI bleeding

1 (7.1%)

19 (36.5%)

0.008^b

Body weight loss

7 (50.0%)

6 (50.0%)

8 (15.4%)

2 (50.0%)

0.010^b

Dysphagia

7 (50.0%)

6 (50.0%)

0.001^b

At least one alarm feature

12 (85.7%)

10 (83.3%)

26 (50.0%)

2 (50.0%)

0.063^b

**Table 4.** The Relationships With Alarm Features and Stages of Gastric Cancers
	Gastric malignancies
^aKruskal-Wallis one-way ANOVA test. ^bPearson’s Chi-square test. ^cFisher’s exact test. Early gastric cancer is defined as adenocarcinoma that is limited to the gastric mucosa or submucosa; late gastric cancer is defined as extend beyond the submucosa. Three patients had more than one alarm features.
Age (years)	66.22 ± 13.80	63.13 ± 14.06	63.43 ± 12.32	0.764^a	56.11 ± 14.84	67.17 ± 11.67	0.009^a	57.10 ± 14.37	72.25 ± 10.08	63.78 ± 12.27	65.40 ± 12.41	0.008^a
Alarm features
GI bleeding	1 (5.6%)	14 (43.8%)	4 (28.6%)	0.018^b	6 (33.3%)	13 (28.3%)	0.690^b	6 (30.0%)	3 (18.8%)	6 (33.3%)	4 (40.0%)	0.673^b
Body weight loss	6 (33.3%)	4 (12.5%)	4 (28.6%)	0.183^b	0	14 (30.4%)	0.007^c	0	6 (37.5%)	6 (33.3%)	2 (20.0%)	0.025^b
Dysphagia	3 (16.7%)	1 (3.1%)	2 (14.3%)	0.111^b	0	6 (13.0%)	0.125^c	0	1 (6.3%)	2 (11.1%)	3 (30.0%)	0.063^b
At least one alarm feature	8 (55.6%)	18 (56.3%)	10 (71.4%)	0.312^b	6 (33.3%)	30 (65.2%)	0.021^b	6 (30.0%)	8 (50.0%)	14 (77.8%)	8 (80.0%)	0.009^b

Table 4. The Relationships With Alarm Features and Stages of Gastric Cancers

Gastric malignancies

Bormann’s classification

Histological classification

AJCC classification

I (n = 18, 28.1%)

II (n = 32, 50.0%)

III (n = 14, 21.9%)

P value

Early (n = 18, 28.1%)

Late (n = 46, 71.9%)

P value

I (n = 20, 31.3%)

II (n = 16, 25.1%)

III (n = 18, 28.1%)

IV (n = 10, 15.6%)

P value

^aKruskal-Wallis one-way ANOVA test. ^bPearson’s Chi-square test. ^cFisher’s exact test. Early gastric cancer is defined as adenocarcinoma that is limited to the gastric mucosa or submucosa; late gastric cancer is defined as extend beyond the submucosa. Three patients had more than one alarm features.

Age (years)

66.22 ± 13.80

63.13 ± 14.06

63.43 ± 12.32

0.764^a

56.11 ± 14.84

67.17 ± 11.67

0.009^a

57.10 ± 14.37

72.25 ± 10.08

63.78 ± 12.27

65.40 ± 12.41

0.008^a

Alarm features

GI bleeding

1 (5.6%)

14 (43.8%)

4 (28.6%)

0.018^b

6 (33.3%)

13 (28.3%)

0.690^b

6 (30.0%)

3 (18.8%)

6 (33.3%)

4 (40.0%)

0.673^b

Body weight loss

6 (33.3%)

4 (12.5%)

4 (28.6%)

0.183^b

14 (30.4%)

0.007^c

6 (37.5%)

6 (33.3%)

2 (20.0%)

0.025^b

Dysphagia

3 (16.7%)

1 (3.1%)

2 (14.3%)

0.111^b

6 (13.0%)

0.125^c

1 (6.3%)

2 (11.1%)

3 (30.0%)

0.063^b

At least one alarm feature

8 (55.6%)

18 (56.3%)

10 (71.4%)

0.312^b

6 (33.3%)

30 (65.2%)

0.021^b

6 (30.0%)

8 (50.0%)

14 (77.8%)

8 (80.0%)

0.009^b