Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan.
Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan.
World J Gastroenterol. 2023 Aug 21;29(31):4763-4773. doi: 10.3748/wjg.v29.i31.4763.
Gastric cancer (GC) incidence based on the endoscopic Kyoto classification of gastritis has not been systematically investigated using time-to-event analysis.
To examine GC incidence in an endoscopic surveillance cohort.
This study was retrospectively conducted at the Toyoshima Endoscopy Clinic. Patients who underwent two or more esophagogastroduodenoscopies were enrolled. GC incidence was based on Kyoto classification scores, such as atrophy, intestinal metaplasia (IM), enlarged folds (EFs), nodularity, diffuse redness (DR), and total Kyoto scores. Hazard ratios (HRs) adjusted for age and sex were calculated using a Cox hazard model.
A total of 6718 patients were enrolled (median age 54.0 years; men 44.2%). During the follow-up period (max 5.02 years; median 2.56 years), GC developed in 34 patients. The average frequency of GCs per year was 0.19%. Kyoto atrophy scores 1 [HR with score 0 as reference: 3.66, 95% confidence interval (CI): 1.06 to 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 to 20.13, = 0.002) and 5-8 (16.45, 6.29-43.03, < 0.001) were more likely to develop GC, whereas the total Kyoto scores 2-3 were not. The HR of the total Kyoto score for developing GC per 1 rank was 1.75 (95%CI: 1.46 to 2.09, < 0.001).
A high total Kyoto score (≥ 4) was associated with GC incidence. The endoscopy-based diagnosis of gastritis can stratify GC risk.
基于内镜京都胃炎分类的胃癌（GC）发病率尚未通过生存时间分析进行系统研究。
检查内镜监测队列中的 GC 发病率。
本研究在 Toyoshima 内镜诊所进行了回顾性研究。纳入了接受过两次或两次以上食管胃十二指肠镜检查的患者。GC 发病率基于京都分类评分，如萎缩、肠化生（IM）、扩大褶皱（EF）、结节、弥漫性发红（DR）和总京都评分。使用 Cox 风险模型计算调整年龄和性别的风险比（HR）。
共纳入 6718 例患者（中位年龄 54.0 岁；男性 44.2%）。在随访期间（最长 5.02 年；中位 2.56 年），34 例患者发生 GC。每年 GC 的平均发生率为 0.19%。京都萎缩评分 1 [以评分 0 为参考的 HR：3.66，95%置信区间（CI）：1.06 至 12.61]、2（11.60，3.82-35.27）、IM 评分 2（9.92，4.37-22.54）、EF 评分 1（4.03，1.63-9.96）、DR 评分 1（6.22，2.65-14.56）和 2（10.01，3.73-26.86）与 GC 发病率相关，而结节评分则不相关。京都总分 4（以京都总分 0-1 为参考的 HR：6.23，95%CI：1.93 至 20.13， = 0.002）和 5-8（16.45，6.29-43.03， < 0.001）总分更有可能发生 GC，而京都总分 2-3 则不然。总京都评分每增加 1 分，发生 GC 的 HR 为 1.75（95%CI：1.46 至 2.09， < 0.001）。
高总京都评分（≥4）与 GC 发病率相关。基于内镜的胃炎诊断可以对 GC 风险进行分层。
