Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2021; 13(5): 125-136
Published online May 16, 2021. doi: 10.4253/wjge.v13.i5.125
Comparison of endoscopic gastritis based on Kyoto classification between diffuse and intestinal gastric cancer
Osamu Toyoshima, Toshihiro Nishizawa, Shuntaro Yoshida, Tomonori Aoki, Fumiko Nagura, Kosuke Sakitani, Yosuke Tsuji, Hayato Nakagawa, Hidekazu Suzuki, Kazuhiko Koike
Osamu Toyoshima, Toshihiro Nishizawa, Shuntaro Yoshida, Kosuke Sakitani, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
Toshihiro Nishizawa, Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan
Tomonori Aoki, Yosuke Tsuji, Hayato Nakagawa, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Fumiko Nagura, Internal Medicine, Chitosefunabashi Ekimae Clinic, Tokyo 157-0054, Japan
Kosuke Sakitani, Department of Gastroenterology, Sakiatani Endoscopy Clinic, Narashino 275-0026, Japan
Hidekazu Suzuki, Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara 259-1193, Japan
Author contributions: Toyoshima O and Nishizawa T designed the study; Toyoshima O analyzed data and wrote the manuscript; Nishizawa T edited the manuscript; Yoshida S, Aoki T, Nagura F, Sakitani K, Tsuji Y, Nakagawa H, Suzuki H, and Koike K revised the manuscript; Suzuki H and Koike K approved the final article.
Institutional review board statement: This study was approved by the Certificated Review Board, Hattori Clinic on September 4th, 2020 (approval no. S2009-U04, registration no. UMIN000018541).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of Toyoshima Endoscopy Clinic.
Conflict-of-interest statement: All other authors have nothing to disclose.
Data sharing statement: Not 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:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Osamu Toyoshima, MD, PhD, Director, Doctor, Department of Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan. t@ichou.com
Received: January 13, 2021
Peer-review started: January 13, 2021
First decision: February 10, 2021
Revised: February 14, 2021
Accepted: April 14, 2021
Article in press: April 14, 2021
Published online: May 16, 2021
BACKGROUND
Gastric cancers can be categorized into diffuse- and intestinal-type cancers based on the Lauren histopathological classification. These two subtypes show distinct differences in metastasis frequency, treatment application, and prognosis. Therefore, accurately assessing the Lauren classification before treatment is crucial. However, studies on the gastritis endoscopy-based Kyoto classification have recently shown that endoscopic diagnosis has improved.
AIM
To investigate patient characteristics including endoscopic gastritis associated with diffuse- and intestinal-type gastric cancers in Helicobacter pylori (H. pylori)-infected patients.
METHODS
Patients who underwent esophagogastroduodenoscopy at the Toyoshima Endoscopy Clinic were enrolled. The Kyoto classification included atrophy, intestinal metaplasia, enlarged folds, nodularity, and diffuse redness. The effects of age, sex, and Kyoto classification score on gastric cancer according to the Lauren classification were analyzed. We developed the Lauren predictive background score based on the coefficients of a logistic regression model using variables independently associated with the Lauren classification. Area under the receiver operative characteristic curve and diagnostic accuracy of this score were examined.
RESULTS
A total of 499 H. pylori-infected patients (49.6% males; average age: 54.9 years) were enrolled; 132 patients with gastric cancer (39 diffuse- and 93 intestinal-type cancers) and 367 cancer-free controls were eligible. Gastric cancer was independently associated with age ≥ 65 years, high atrophy score, high intestinal metaplasia score, and low nodularity score when compared to the control. Factors independently associated with intestinal-type cancer were age ≥ 65 years (coefficient: 1.98), male sex (coefficient: 1.02), high intestinal metaplasia score (coefficient: 0.68), and low enlarged folds score (coefficient: -1.31) when compared to diffuse-type cancer. The Lauren predictive background score was defined as the sum of +2 (age ≥ 65 years), +1 (male sex), +1 (endoscopic intestinal metaplasia), and -1 (endoscopic enlarged folds) points. Area under the receiver operative characteristic curve of the Lauren predictive background score was 0.828 for predicting intestinal-type cancer. With a cut-off value of +2, the sensitivity, specificity, and accuracy of the Lauren predictive background score were 81.7%, 71.8%, and 78.8%, respectively.
CONCLUSION
Patient backgrounds, such as age, sex, endoscopic intestinal metaplasia, and endoscopic enlarged folds are useful for predicting the Lauren type of gastric cancer.
Core Tip: Accurately assessing the Lauren classification before the treatment of gastric cancer is crucial. Factors independently associated with intestinal-type cancer were age ≥ 65 years, male sex, high endoscopic intestinal metaplasia score, and low endoscopic enlarged folds score when compared to diffuse-type cancer. The Lauren predictive background score was defined as the sum of +2 (age ≥ 65 years), +1 (male), +1 (intestinal metaplasia), and -1 (enlarged folds) points. Area under the curve of the Lauren predictive background score was 0.828 (cut-off: +2) for predicting intestinal-type cancer. Age, sex, intestinal metaplasia, and enlarged folds are useful for predicting tumor type.
