Gastritis OLGA-staging & gastric cancer risk: a twelve year clinico-pathological follow-up study
Résumé
Background: Intestinal-type gastric cancer (GC) still ranks among the high-incidence, highly lethal malignancies. Atrophic gastritis is the cancerization field in which GC develops. The current histological reporting formats for gastritis do not include any (atrophy-based) ranking of GC risk. Aim: This clinico-pathological long-term follow-up study tested the gastritis OLGA-staging in prognosticating neoplastic progression. Methods: Ninety-three Italian patients were followed up for more than 12 years (range=144-204 months). Clinical examinations, pepsinogen serology, endoscopy and histology (also assessing H. pylori status) were done both at enrolment (T1) and at the end of the follow-up (T2). Results: All invasive or intra-epithelial gastric neoplasia were consistently associated with high-risk (III/IV) OLGA stages. There was a significant inverse correlation between the mean pepsinogen ratio and the OLGA stage (test for trend; p<0.001). OLGA staging at T1 predicted both the OLGA stage (Kaplan Maier log rank test, p=0.001) and the neoplasia at T2 (Kaplan Maier log rank test, p=0.001). Conclusions: This long-term follow-up study provides the first evidence that gastritis OLGA-staging conveys relevant information on the clinico-pathological outcome of gastritis and, therefore, for patient management. According to OLGA-staging and H. pylori-status, gastritis patients could be confidently stratified and managed according to their different cancer risk.
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