Endoscopic grading of gastric atrophy and histological gastritis staging on risk assessment for early gastric cancer: A case–control study

Objectives To assess the predictive value of endoscopic grading of gastric atrophy using Kimura–Takemoto classification, histological grading systems of operative link on gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia (OLGIM) on risk stratification for early gastric cancer (EGC) and other potential risk factors of EGC. Methods A single‐center, case–control study was retrospectively conducted including 68 patients with EGC treated with endoscopic submucosal dissection and 68 age‐ and sex‐matched control subjects. Kimura–Takemoto classification, OLGA and OLGIM systems, and other potential risk factors were evaluated between the two groups. Results Of the 68 EGC lesions, 22 (32.4%) were well differentiated, 38 (55.9%) were moderately differentiated, and 8 (11.8%) were poorly differentiated, respectively. Multivariate analysis revealed O‐type Kimura–Takemoto classification (adjusted odds ratio [AOR] 3.282, 95% confidence interval [CI] 1.106–9.744, P = 0.032) and OLGIM stage III/IV (AOR 17.939, 95% CI 1.874–171.722, P = 0.012) were significantly related to a higher risk of EGC. Especially, O‐type Kimura–Takemoto classification within 6–12 months before EGC diagnosis (AOR 4.780, 95% CI 1.650–13.845, P = 0.004) was independently associated with EGC risk. Areas under the receiver operating characteristic curve of the three systems for EGC were comparable. Conclusions Endoscopic Kimura–Takemoto classification and histological OLGIM stage III/IV are independent risk factors for EGC, which may reduce the need for biopsies in risk stratification of EGC. Further multicenter prospective studies of large sizes are needed. O‐type Kimura–Takemoto classification and the operative link on gastric intestinal metaplasia (OLGIM) stages III/IV are useful tools to assess the risk of EGC. Especially, patients with O‐type Kimura–Takemoto classification may progress more frequently and rapidly to EGC within 6–12 months than those of patients with C‐type Kimura–Takemoto classification