Kyoto classification risk scoring system and endoscopic grading of gastric intestinal metaplasia for gastric cancer: Multicenter observation study in Japan
Kyoto classification risk scoring system and endoscopic grading of gastric intestinal metaplasia for gastric cancer: Multicenter observation study in Japan
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DOI：
10.1111/den.14114
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发表时间：
2021-09-16
影响因子：
5.3
通讯作者：
Shimokawa, Toshio
中科院分区：
文献类型：
--
作者：
Kawamura, Masashi;Uedo, Noriya;Shimokawa, Toshio
目的在日本的临床实践中，内镜和组织学风险评估对胃癌（GC）的有用性尚未得到充分研究。方法在这项多中心观察研究中，GC和非GC患者在10个日本机构前瞻性入组。所有患者均采用京都分级风险评分系统、Kimura-Takemoto内镜下萎缩分级、内镜下胃肠上皮化生分级（EGGIM）、胃炎手术环节评估（OLGA）和胃肠上皮化生手术环节评估（OLGIM）。与GC风险的关联强度进行了比较。此外，还确定了京都分类中的重要内窥镜检查结果。结果共分析了115例GC和265例非GC患者。在单因素分析中，每种危险分层方法均与GC风险显著相关。在多变量分析中，OLGIM III/IV期（比值比[OR] 2.8 [95%CI 1.5-5.3]）、高EGGIM评分（OR 1.8 [1.0-3.1]）和开放型Kimura-Takemoto（OR 2.5 [1.4-4.5]）与GC风险显著相关。在京都分类中，开放型内镜下萎缩、不可见的集合小静脉（RAC）规则排列、图像增强内镜下胃体广泛（>30%）肠上皮化生和胃体地图样发红是独立的高危内镜表现。使用这四个结果的修改后的京都分类风险评分系统显示了更好的受试者工作特征曲线下面积值（0.750，P = 0.052）比原始京都分类（0.706）。结论OLGIM III/IV期、高EGGIM评分和开放型Kimura-Takemoto与日本患者的GC风险密切相关。改进后的京都分类风险评分系统可用于GC风险评估，需要进一步验证。（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).