Observational Study
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
Research background

The accurate diagnosis of gastric cancer using the Lauren classification is crucial.

Research motivation

The relationship between the Lauren classification and endoscopic findings based on the Kyoto classification is not clear.

Research objectives

To investigate the background patient characteristics and endoscopic gastritis of patients with diffuse- and intestinal-type gastric cancers, focusing on Helicobacter pylori (H. pylori)-infected patients.

Research methods

This study included participants who underwent esophagogastroduodenoscopy at the Toyoshima Endoscopy Clinic. The endoscopy-based Kyoto classification of gastritis consisted of 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.

Research results

A total of 499 H. pylori-infected patients (49.6% males; average age, 54.9 years) were enrolled. A total of 132 patients with gastric cancer (39 diffuse- and 93 intestinal-type) 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, male sex, high intestinal metaplasia score, and low enlarged folds score when compared to diffuse-type cancer. The Lauren predictive background score was defined as the sum of the following points: +2 points for an age of ≥ 65 years, +1 point for male sex, +1 point for intestinal metaplasia, and -1 point for enlarged folds. The area under the curve of the Lauren predictive background score was 0.828 for predicting intestinal-type tumors. With a cut-off of +2, the sensitivity and specificity of the Lauren predictive background score were 81.7% and 71.8%, respectively.

Research conclusions

Patient backgrounds such as age, sex, endoscopic intestinal metaplasia, and endoscopic enlarged folds are useful for predicting tumor type.

Research perspectives

Studying subjects after H. pylori eradication or H. pylori-uninfected subjects in the future is warranted. Furthermore, comparisons between the endoscopic background diagnosis of patients with gastric cancer (especially according to Lauren classification) and that of non-cancer controls is desired.