Introduction

Gastric cancer (GC) incidence based on the endoscopic Kyoto classification of gastritis has not been systematically investigated using time-to-event analysis. Therefore, we examined GC incidence in an endoscopic surveillance cohort.

Aims & Methods

This study was retrospectively conducted at the Toyoshima Endoscopy Clinic. Patients who underwent two or more esophagogastroduodenoscopies (EGDs) were enrolled. GC incidence was based on Kyoto classification scores, such as atrophy, intestinal metaplasia (IM), enlarged folds (EF), nodularity, diffuse redness (DR), and total Kyoto scores. Atrophy was classified using the Kimura-Takemoto classification. Non-atrophy and Closed I, Closed II and III, and Open I to III were scored as atrophy scores of 0, 1, and 2, respectively. IM scores of 0, 1, and 2 were defined as the absence of IM, IM limited to the antrum, and IM extending into the corpus, respectively. The absence and presence of EF were scored as 0 and 1, respectively. The absence and presence of nodularity were scored 0 and 1, respectively. DR scores of 0, 1, and 2 were defined as the absence of DR, mild DR and/or DR with partial regular arrangement of collecting venules (RAC), and severe DR without RAC, respectively. The endoscopists diagnosed the Kyoto classification scores on-site during the index EGD. Hazard ratios [HRs] adjusted for age and sex were calculated using a Cox hazard model. This study was approved by the institutional review board of the Yoyogi Mental Clinic (approval no. RKK227).

Results

A total of 6718 patients were enrolled (mean age 55.0 years; men 44.2%). Of them, 3754, 2264, 700 patients were in H. pylori uninfected, eradicated, and currently infected status, respectively. Patients were followed up for up to 5.02 years. The mean Kyoto classification scores for atrophy, IM, EF, nodularity, DR, and total Kyoto were 0.585, 0.284, 0.039, 0.026, 0.312, and 1.247, respectively. During the follow-up period, 37 GCs occurred in 34 patients. All GCs were superficial and within the submucosal depth. Lauren’s intestinal type made up 89.1% of GCs. The annual incidence rates of GC were 0.04%, 0.17%, and 0.73% for atrophy scores of 0, 1, and 2; 0.07%, 0.25%, and 1.10% for IM scores of 0, 1, and 2; 0.17% and 0.92% for EF scores of 0 and 1; and 0.06%, 0.55%, and 0.74% for DR scores of 0, 1, and 2, respectively. The annual incidence rate of GC was 0.19%. The GC incidence rates were 0.05, 0.07, 0.47, and 1.27%/year for the total Kyoto scores of 0-1, 2-3, 4, and 5-8, respectively. Multivariate analysis showed that Kyoto atrophy scores 1 (HR with score 0 as reference: 3.66, 95% confidence interval [CI]: 1.06-12.61), 2 (11.60, 3.82-35.27), IM score 2 (9.92, 4.37-22.54), EF score 1 (4.03, 1.63-9.96), DR scores 1 (6.22, 2.65-14.56), and 2 (10.01, 3.73-26.86) were associated with GC incidence, whereas nodularity scores were not. The total Kyoto scores of 4 (HR with total Kyoto scores 0-1 as reference: 6.23, 95% CI: 1.93-20.13) and 5-8 (16.45, 6.29-43.03) were more likely to develop GC, whereas the total Kyoto scores 2-3 were not, as shown in table. The HR of the total Kyoto score for developing GC per 1 rank was 1.75 (95% CI: 1.46-2.09, P<0.001).

Conclusion

A high total Kyoto score (≥ 4) was associated with GC incidence. The endoscopy-based diagnosis of gastritis can stratify GC risk.

Disclosure

All authors disclosed no personal conflicts of interest.