OLGA Gastritis Staging for the Prediction of Gastric Cancer Risk: A Long-term Follow-up Study of 7436 Patients.

Abstract

OBJECTIVES:

Gastritis OLGA-staging ranks the risk for gastric cancer (GC) in progressive stages (0-IV). This long-term follow-up study quantifies the GC risk associated with each OLGA stage.

METHODS:

Consecutive patients (7436) underwent esophagogastroscopy (T-0), with mapped gastric biopsies, OLGA staging, and H. pylori status assessment. Patients with neoplastic lesion (invasive or non-invasive) at the index endoscopy (and/or within 12 months) were excluded. All patients were followed-up (T-1) by combining different sources of clinical/pathological information (Regional Registries of: (i) esophagogastroduodenoscopies; (ii) pathology reports; (iii) cancer, (iv) mortality). The endpoint was histologically documented development of gastric epithelial neoplasia.

RESULTS:

At T-0, the patients' distribution by OLGA stage was: Stage 0 = 80.8%; Stage I = 12.6%; Stage II = 4.3%; Stage III = 2.0%; Stage IV = 0.3%; H. pylori infection was detected in 25.9% of patients. At the end of the follow-up (mean/median = 6.3/6.6 years), 28 incident neoplasia were documented (overall prevalence = 0.60 per 103/person-years; low-grade intraepithelial neoplasia = 17/28; high-grade intraepithelial neoplasia = 4/28; GC = 7/28). By OLGA stage at the enrollment, the rate of incident neoplasia was: Stage 0 = 1 case; rate/103 person-years = 0.03; 95%CI: 0.004-0.19; Stage I = 2 cases; rate/103 person-years = 0.34; 95%CI: 0.09-1.36; Stage II = 3 cases; rate/103 person-years = 1.48; 95%CI: 0.48-4.58; Stage III = 17 cases; rate/103 person-years = 19.1; 95%CI: 11.9-30.7; Stage IV = 5 cases; rate/103 person-years = 41.2; 95%CI: 17.2-99.3. Multivariate analysis including gender, age, H. pylori status, and OLGA stage at enrollment only disclosed OLGA stage as predictor of neoplastic progression (OLGA stage III: HR = 712.4, 95%CI = 92.543-5484.5; OLGA stage IV: HR = 1450.7, 95%CI = 166.7-12626.0).

CONCLUSIONS:

Among 7436 patients, OLGA stages at the enrollment correlated significantly with different risk for gastric neoplasia. Based on the obtained results, gastritis staging is a critical adjunct in endoscopy follow-up protocols aimed at GC secondary prevention.

• Authors: Massimo Rugge, Robert M Genta, Matteo Fassan, Elisa Valentini, Irene Coati, Stefano Guzzinati, Edoardo Savarino, Manuel Zorzi, Fabio Farinati, Peter Malfertheiner
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 113 Issue 11 Pg. 1621-1628 (11 2018) ISSN: 1572-0241 [Electronic] United States
• PMID: 30333540 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Biopsy
• Disease Progression
• Endoscopy, Digestive System
• Female
• Follow-Up Studies
• Gastric Mucosa (diagnostic imaging, pathology)
• Gastritis (diagnosis, microbiology, pathology)
• Helicobacter Infections (diagnosis, microbiology, pathology)
• Helicobacter pylori (isolation & purification)
• Humans
• Incidence
• Male
• Middle Aged
• Precancerous Conditions (diagnosis, microbiology, pathology)
• Prognosis
• Registries (statistics & numerical data)
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Stomach Neoplasms (diagnosis, epidemiology, pathology)
• Survival Analysis
• Young Adult