Development and validation of a risk stratification model for early-onset gastric cancer based on clinical features and Helicobacter pylori serological detection of virulence factors

BACKGROUND: Early-onset gastric cancer (EOGC), diagnosed before age 45, demonstrates distinct clinicopathological features and poorer prognosis. Current screening strategies lack sensitivity in young populations, while Helicobacter pylori (H. pylori) virulence genotypes (e.g., cagA, vacA) remain underutilized in risk stratification. To develop and validate a diagnostic model combining clinical characteristics and H. pylori virulence serological detection of virulence factors to optimize EOGC risk stratification. METHODS: In this multicenter case-control study, 200 histologically confirmed EOGC patients and 600 age-matched controls (non-malignant gastric conditions) were enrolled from LiShui Hospital (2023-2024). Clinical parameters, H. pylori infection status (13C-urea breath test), and virulence genotypes (cagA, vacA; ELISA) were analyzed. Multivariable logistic regression identified independent risk factors, followed by risk score development and internal validation (1000 bootstrap replicates). RESULTS: /L; aOR=1.98, CI: 1.32-2.96), and weight loss >2.1 kg (aOR=2.57, CI: 1.21-2.73). A score ≥3 indicated high risk, achieving 86.5% sensitivity and 82.3% specificity (AUC=0.89, CI: 0.85-0.93). CONCLUSIONS: This novel model integrates accessible clinical and microbiological markers to stratify EOGC risk with high accuracy, providing a cost-effective tool for prioritizing endoscopic evaluation in young symptomatic individuals.