Comparison of operative link for gastritis assessment, operative link on gastric intestinal metaplasia assessment, and TAIM stagings among men with atrophic gastritis.
Gastric cancer is the world's third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia assessment (OLGIM), have been developed to detect high gastric cancer risk. European guidelines recommend surveillance for high-risk OLGA/OLGIM patients (stages III-IV), and for those with advanced stage of atrophic gastritis in the whole stomach mucosa. We hypothesize, that by combining atrophy and intestinal metaplasia into one staging named TAIM, more patients with increased gastric cancer risk could be detected.
To evaluate the clinical value of the OLGA, OLGIM, and novel TAIM stagings as prognostic indicators for gastric cancer.
In the Helsinki Gastritis Study, 22346 elderly male smokers from southwestern Finland were screened for serum pepsinogen I (PGI). Between the years 1989 and 1993, men with low PGI values (PGI < 25 μg/L), were invited to undergo an oesophagogastroduodenoscopy. In this retrospective cohort study, 1147 men that underwent gastroscopy were followed for gastric cancer for a median of 13.7 years, and a maximum of 27.3 years. We developed a new staging system, TAIM, by combining the topography with the severity of atrophy or intestinal metaplasia in gastric biopsies. In TAIM staging, the gastric cancer risk is classified as low or high.
Twenty-eight gastric cancers were diagnosed during the follow-up, and the incidence rate was 1.72 per 1000 patient-years. The cancer risk associated positively with TAIM [Hazard ratio (HR) 2.70, 95%CI: 1.09-6.69, P = 0.03]. The risk increased through OLGIM stages 0-IV (0 vs IV: HR 5.72, 95%CI: 1.03-31.77, P for trend = 0.004), but not through OLGA stages 0-IV (0 vs IV: HR 5.77, 95%CI: 0.67-49.77, P for trend = 0.10). The sensitivities of OLGA and OLGIM stages III-IV were low, 21% and 32%, respectively, whereas that of TAIM high-risk was good, 79%. On the contrary, OLGA and OLGIM had high specificity, 85% and 81%, respectively, but TAIM showed low specificity, 42%. In all three staging systems, the high-risk men had three- to four-times higher gastric cancer risk compared to the general male population of the same age.
OLGIM and TAIM stagings show prognostic value in assessing gastric cancer risk in elderly male smokers with atrophic gastritis.
Nieminen AA
，Kontto J
，Puolakkainen P
，Virtamo J
，Kokkola A
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The staging of gastritis with the OLGA system by using intestinal metaplasia as an accurate alternative for atrophic gastritis.
The OLGA (operative link on gastritis assessment) staging system is based on severity of atrophic gastritis (AG). AG remains a difficult histopathologic diagnosis with low interobserver agreement, whereas intestinal metaplasia (IM) is associated with high interobserver agreement.
The aim of this study was to evaluate whether a staging system based on IM is preferable to estimate gastric cancer risk.
Prospective multicenter study.
A total of 125 patients previously diagnosed with gastric IM or dysplasia.
Surveillance endoscopy with extensive biopsy sampling.
Three pathologists graded biopsy specimens according to the Sydney classification. Interobserver agreement was analyzed by kappa statistics. In the OLGA, AG was replaced by IM, creating the OLGIM.
Interobserver agreement was fair for dysplasia (kappa = 0.4), substantial for AG (kappa = 0.6), almost perfect for IM (kappa = 0.9), and improved for all stages of OLGIM compared with OLGA. Overall, 84 (67%) and 79 (63%) patients were classified as stage I-IV according to OLGA and OLGIM, respectively. Of the dysplasia patients, 5 (71%) and 6 (86%) clustered in stage III-IV of OLGA and OLGIM, respectively.
Prospective studies should confirm the correlation between gastric cancer risk and OLGIM stages.
Replacement of AG by IM in the staging of gastritis considerably increases interobserver agreement. The correlation with the severity of gastritis remains at least as strong. Therefore, the OLGIM may be preferred over the OLGA for the prediction of gastric cancer risk in patients with premalignant lesions.
Capelle LG
，de Vries AC
，Haringsma J
，Ter Borg F
，de Vries RA
，Bruno MJ
，van Dekken H
，Meijer J
，van Grieken NC
，Kuipers EJ
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