Endoscopic grading of gastric atrophy and histological gastritis staging on risk assessment for early gastric cancer: a case-control study.

Abstract

To assess the predictive value of endoscopic grading of gastric atrophy (Kimura-Takemoto classification), histological grading systems of operative link on gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia (OLGIM) on risk stratification for early gastric cancer (EGC) and to investigate other potential risk factors of EGC. A single center, case-control study was conducted including 68 patients with EGC treated with endoscopic submucosal dissection and 68 age and sex-matched control subjects. Kimura-Takemoto classification, OLGA and OLGIM systems, and other potential risk factors were evaluated between the two groups. Of the 68 EGCs, 22 (32.4%) were well differentiated, 38 (55.9%) with moderately differentiated, and 8 (11.8%) with poorly differentiated. Multivariate analysis revealed O-type Kimura-Takemoto classification (AOR 3.282, 95%CI 1.106-9.744, P=0.032) and OLGIM stage III/IV (AOR 17.939, 95%CI 1.874-171.722, P=0.012) were significantly related to higher risk of EGC. Especially, O-type Kimura-Takemoto classification (AOR 4.78, 95%CI 1.65-13.845, P=0.004) had independently significant association with the EGC risk within 6-12 months. AUCs of the three systems for EGC were similar. This study confirms the role of endoscopic Kimura-Takemoto classification and histological OLGIM stage III/IV as independent risk factors for EGC. It may simplify every day practice by reducing the need for biopsies to stratify EGC risk. Further muti-center prospective study of large size is needed. This article is protected by copyright. All rights reserved.