Masashi Kawamura1, Noriya Uedo2, Tomoyuki Koike3, Takashi Kanesaka2, Waku Hatta3, Yohei Ogata3, Tomoyuki Oikawa4, Wataru Iwai4, Satoshi Yokosawa5, Junya Honda5, Sho Asonuma6, Hideki Okata6, Motoki Ohyauchi7, Hirotaka Ito7, Yasuhiko Abe8, Nobuyuki Ara9, Shoichi Kayaba10, Hirohiko Shinkai10, Toshio Shimokawa11. 1. Department of Gastroenterology, Sendai City Hospital, Miyagi, Japan. 2. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan. 3. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan. 4. Department of Gastroenterology, Miyagi Cancer Center, Miyagi, Japan. 5. Department of Gastroenterology, Iwate Prefectural Iwai Hospital, Iwate, Japan. 6. Department of Gastroenterology, South Miyagi Medical Center, Miyagi, Japan. 7. Department of Gastroenterology, Osaki Citizen Hospital, Miyagi, Japan. 8. Division of Endoscopy, Yamagata University Hospital, Yamagata, Japan. 9. Department of Gastroenterology, National Hospital Organization Sendai Medical Center, Miyagi, Japan. 10. Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Iwate, Japan. 11. Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan.
Abstract
OBJECTIVES: The usefulness of endoscopic and histological risk assessment for gastric cancer (GC) has not been fully investigated in Japanese clinical practice. METHODS: In this multicenter observation study, GC and non-GC patients were prospectively enrolled in 10 Japanese facilities. The Kyoto classification risk scoring system, the Kimura-Takemoto endoscopic atrophy classification, the endoscopic grading of gastric intestinal metaplasia (EGGIM), the operative link on gastritis assessment (OLGA) and the operative link on gastric intestinal metaplasia assessment (OLGIM) were applied to all patients. The strength of an association with GC risk was compared. In addition, important endoscopic findings in the Kyoto classification were identified. RESULTS: Overall, 115 GC and 265 non-GC patients were analyzed. Each risk stratification method had a significant association with GC risk in univariate analysis. In multivariate analysis, OLGIM stage III/IV (odds ratio [OR] 2.8 [95% CI 1.5-5.3]), high EGGIM score (OR 1.8 [1.0-3.1]) and opened-type Kimura-Takemoto (OR 2.5 [1.4-4.5]) had significant associations with GC risk. In the Kyoto classification, opened-type endoscopic atrophy, invisible regular arrangement of collecting venules (RAC), extensive (>30%) intestinal metaplasia in the corpus in image-enhanced endoscopy, and map-like redness in the corpus were independent high-risk endoscopic findings. The modified Kyoto classification risk scoring system using these four findings demonstrated a better area under the receiver operating characteristic curve value (0.750, P = 0.052) than that of the original Kyoto classification (0.706). CONCLUSIONS: The OLGIM stage III/IV, high EGGIM score and open-typed Kimura-Takemoto had strong association with GC risk in Japanese patients. The modified Kyoto classification risk scoring system may be useful for GC risk assessment, which warrants further validation. (UMIN000027023).
OBJECTIVES: The usefulness of endoscopic and histological risk assessment for gastric cancer (GC) has not been fully investigated in Japanese clinical practice. METHODS: In this multicenter observation study, GC and non-GC patients were prospectively enrolled in 10 Japanese facilities. The Kyoto classification risk scoring system, the Kimura-Takemoto endoscopic atrophy classification, the endoscopic grading of gastric intestinal metaplasia (EGGIM), the operative link on gastritis assessment (OLGA) and the operative link on gastric intestinal metaplasia assessment (OLGIM) were applied to all patients. The strength of an association with GC risk was compared. In addition, important endoscopic findings in the Kyoto classification were identified. RESULTS: Overall, 115 GC and 265 non-GC patients were analyzed. Each risk stratification method had a significant association with GC risk in univariate analysis. In multivariate analysis, OLGIM stage III/IV (odds ratio [OR] 2.8 [95% CI 1.5-5.3]), high EGGIM score (OR 1.8 [1.0-3.1]) and opened-type Kimura-Takemoto (OR 2.5 [1.4-4.5]) had significant associations with GC risk. In the Kyoto classification, opened-type endoscopic atrophy, invisible regular arrangement of collecting venules (RAC), extensive (>30%) intestinal metaplasia in the corpus in image-enhanced endoscopy, and map-like redness in the corpus were independent high-risk endoscopic findings. The modified Kyoto classification risk scoring system using these four findings demonstrated a better area under the receiver operating characteristic curve value (0.750, P = 0.052) than that of the original Kyoto classification (0.706). CONCLUSIONS: The OLGIM stage III/IV, high EGGIM score and open-typed Kimura-Takemoto had strong association with GC risk in Japanese patients. The modified Kyoto classification risk scoring system may be useful for GC risk assessment, which warrants further validation. (UMIN000027023).