Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2016; 22(13): 3670-3678
Published online Apr 7, 2016. doi: 10.3748/wjg.v22.i13.3670
Operative link on gastritis assessment stage is an appropriate predictor of early gastric cancer
Ying Zhou, Hai-Yan Li, Jing-Jing Zhang, Xiao-Yu Chen, Zhi-Zheng Ge, Xiao-Bo Li
Ying Zhou, Hai-Yan Li, Jing-Jing Zhang, Xiao-Yu Chen, Zhi-Zheng Ge, Xiao-Bo Li, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200001, China
Author contributions: Zhou Y participated in the study design and data collection, performed the oversight of the study and statistical analysis, and drafted and revised the manuscript; Li HY participated in the study design and data collection; Zhang JJ participated in the data collection and modified the manuscript for important intellectual content; Chen XY performed the data collection and analysis; Ge ZZ performed the data collection and analysis; Li XB participated in the study design and data collection, performed statistical analysis, and modified the manuscript for important intellectual content; all authors read and approved the final manuscript.
Institutional review board statement: All biopsy specimens were taken after informed consent, and ethical permission was obtained from each of the patients who participated in the study.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Data sharing statement: No additional unpublished data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiao-Bo Li, MD, PhD, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai 200001, China. lxb_1969@163.com
Telephone: +86-21-58394262 Fax: +86-21-58394262
Received: December 7, 2015
Peer-review started: December 8, 2015
First decision: January 13, 2016
Revised: January 25, 2016
Accepted: February 22, 2016
Article in press: February 22, 2016
Published online: April 7, 2016
Abstract

AIM: To assess the predictive value of Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) stages in gastric cancer.

METHODS: A prospective study was conducted with 71 patients with early gastric cancer (EGC) and 156 patients with non-EGC. All patients underwent endoscopic examination and systematic biopsy. Outcome measures were assessed and compared, including the Japanese endoscopic gastric atrophy (EGA) classification method and the modified OLGA method as well as the modified OLGIM method. Helicobacter pylori (H. pylori) status was determined for all study participants. Stepwise logistic regression modeling was performed to analyze correlations between EGC and the EGA, OLGA and OLGIM methods.

RESULTS: For patients with EGC and patients with non-EGC, the proportions of moderate-to-severe EGA cases were 64.8% and 44.9%, respectively (P = 0.005), the proportions of OLGA stages III-IV cases were 52.1% and 22.4%, respectively (P < 0.001), and the proportions of OLGIM stages III-IV cases were 42.3% and 19.9%, respectively (P < 0.001). OLGA stage and OLGIM stage were significantly related to EGA classification; specifically, logistic regression modeling showed significant correlations between EGC and moderate-to-severe EGA (OR = 1.95, 95% CI: 1.06-3.58, P = 0.031) and OLGA stages III-IV (OR = 3.14, 95%CI: 1.71-5.81, P < 0.001), but no significant correlation between EGC and OLGIM stages III-IV (P = 0.781). H. pylori infection rate was significantly higher in patients with moderate-to-severe EGA (75.0% vs 54.1%, P = 0.001) or OLGA/OLGIM stages III-IV (OLGA: 83.6% vs 55.8%, P < 0.001; OLGIM: 83.6% vs 57.8%, P < 0.001).

CONCLUSION: OLGA classification is optimal for EGC screening. A surveillance program including OLGA stage and H. pylori infection status may facilitate early detection of gastric cancer.

Keywords: Early gastric cancer, Operative Link on Gastritis Assessment/Operative Link on Gastric Intestinal Metaplasia Assessment stage, Endoscopic gastric atrophy classification, Screening, Endoscopy

Core tip: Japanese endoscopic gastric atrophy classification, Operative Link on Gastritis Assessment (OLGA), and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) have been proven separately as effective methods to evaluate severity of gastric atrophy and intestinal metaplasia. However, these methods have not been compared for prognosticating neoplastic development. This study compared the correlations of these three methods with early gastric cancer (EGC) and found that OLGA classification is optimal for EGC screening. A surveillance program based on OLGA stage and Helicobacter pylori infection status may represent a practical approach for detecting gastric cancer at an early stage.