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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Gastric cancer incidence based on endoscopic Kyoto classification of gastritis
Osamu Toyoshima, Toshihiro Nishizawa, Shuntaro Yoshida, Tatsuya Matsuno, Gota Fujisawa, Akira Toyoshima, Hirotoshi Ebinuma, Mitsuhiro Fujishiro, Yutaka Saito, Hidekazu Suzuki
Osamu Toyoshima, Shuntaro Yoshida, Tatsuya Matsuno, Gota Fujisawa, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
Toshihiro Nishizawa, Hirotoshi Ebinuma, Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan
Akira Toyoshima, Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan
Mitsuhiro Fujishiro, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Yutaka Saito, Division of Endoscopy, National Cancer Center Hospital, Tokyo 104-0045, Japan
Hidekazu Suzuki, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara 259-1193, Japan
Author contributions: Toyoshima O, Nishizawa T, Yoshida S, Matsuno T, Fujisawa G, and Toyoshima A contributed to the conception of article; Toyoshima O drafted the article; Toyoshima O, Nishizawa T, Yoshida S, and Matsuno T involved in the review of endoscopic images; Toyoshima O contributed to the statistical analysis; Nishizawa T edited the article; Toyoshima O, Nishizawa T, Yoshida S, Matsuno T, Fujisawa G, Toyoshima A, Ebinuma H, Fujishiro M, Saito Y, and Suzuki H contributed to the critical review; and all authors approved the final manuscript.
Institutional review board statement: This study was approved by the institutional review board of the Yoyogi Mental Clinic (approval no. RKK227).
Informed consent statement: Written informed consent was obtained from patients at the time of esophagogastroduodenoscopy to use their data for research purposes. The study’s protocol was published on our institute’s website (
www.ichou.com) so that patients could opt out of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Toshihiro Nishizawa, MD, PhD, Professor, Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Hatakeda 852, Narita, Chiba, Narita 286-8520, Japan. nisizawa@kf7.so-net.ne.jp
Received: June 3, 2023
Peer-review started: June 3, 2023
First decision: July 10, 2023
Revised: July 20, 2023
Accepted: July 28, 2023
Article in press: July 28, 2023
Published online: August 21, 2023
BACKGROUND
Gastric cancer (GC) incidence based on the endoscopic Kyoto classification of gastritis has not been systematically investigated using time-to-event analysis.
AIM
To examine GC incidence in an endoscopic surveillance cohort.
METHODS
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.
RESULTS
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, P = 0.002) and 5-8 (16.45, 6.29-43.03, P < 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, 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.
Core Tip: A high total Kyoto score (≥ 4) was associated with gastric cancer (GC) incidence. Adjusted hazard ratios (HRs) for the total Kyoto scores of 4 and 5-8 were high at 6.23 and 16.45, respectively, compared to the total Kyoto scores of 0-1. The HR of the total Kyoto score for developing GC per 1 rank was 1.75.
