Helicobacter Pylori Infection Combined With OLGA And OLGIM Staging Systems For Risk Assessment Of Gastric Cancer

Objective To investigate the relationship between the chronic atrophic gastritis(CAG)assessment system(OLGA and OLGIM staging systems)and gastric mucosal serology,Helicobacter pylori(Hp),and to analyze the risk factors for OLGA and OLGIM stagesⅢ-Ⅳ in an attempt to find the clinical diagnostic value of potentially appropriate gastric mucosal serology indicators in a high-risk population for GC in eastern China.Finally,the population characteristics of those who progressed to gastric cancer(GC)were summarized by retrospectively following patients with CAG and validating the appropriate timing of endoscopic surveillance in high-risk groups.Methods Patients who underwent gastroscopy with standardized gastric mucosal sampling and related serological tests(including PGI,PGII,G-17)along with carbon 13C/14C-urea breath test from April 2015 to April 2020 at the physical examination center and outpatient endoscopy center of Provincial Hospital affiliated to Anhui Medical University were included,using the OLGA and OLGIM staging systems for the gastric atrophic(GA)and intestinal metaplasia(IM)populations.In addition,demographic information was collected for them.The relationship between gastric mucosal serology,Hp infection status,and demographics of patients with different OLGA/OLGIM staging was analyzed.To compare gastric mucosal serology levels based on stage Ⅰ-Ⅱ and Ⅲ-Ⅳ populations with Hp infection status.To analyze independent risk factors for OLGA/OLGIM stages Ⅲ-Ⅳ and gastric mucosal serum-related indicators for the diagnosis of OLGA/OLGIM stages Ⅲ-Ⅳ by plotting ROC curves.Finally,a real-world retrospective follow-up of the study population was focused on in December 2021,and the characteristics of CAG patients progressing to GC were summarized.Results 1)609 patients were diagnosed with CAG,and the Hp infection rate in patients with CAG was 42.5%.184(30.21%),264(43.35%),99(16.26%)and 62(10.18%)patients were in stages Ⅰ-Ⅳ,respectively,according to OLGA staging;527 of them were patients with metaplastic atrophy,and the Hp infection rate in metaplastic atrophy was 38.8%.And 192(36.43%),178(33.78%),112(21.25%),and 45(8.54%)patients were in stages Ⅰ-Ⅳ,respectively,according to OLGIM staging.2)Statistical differences in serum PGI,PGR,G-17,ratio of family history of gastrointestinal tumors(p<0.001)and Hp infection rate(P=0.002)between stages were seen in 609 CAG patients in OLGA stages.With increasing OLGA stage,PGI and PGR levels decreased,while Hp infection rate increased.the highest G-17 levels and family history ratio were found in OLGA stage Ⅳ.Also,for 527 of the patients with metaplastic atrophic gastritis after OLGIM staging,significant differences could be found between OLGIM Ⅰ-Ⅳ stages in serum PGI(P=0.001),PGR(P<0.001),PGII(P<0.001),G-17(P<0.001),Hp infection rate(P<0.001)and the ratio of family history of gastrointestinal tumors(P=0.008).In addition,the mean age of patients with OLGIM stages Ⅲ and Ⅳ was older than that of patients with OLGIM stages Ⅰ and Ⅱ(P=0.003).3)We found statistically significant levels of PGI,PGII,PGR,and G-17 between the Hp-positive and Hp-negative groups in both the OLGA system and the OLGIM system,regardless of stages Ⅰ-Ⅱ or Ⅲ-Ⅳ patients(all P<0.05).The results showed that patients in the Hp-positive group had higher levels of PGI,PGII,and G-17 than those in the Hp-negative group,while PGR levels were lower than those in the Hp-negative group.In the OLGA staging,both PGI and PGII levels were lower in Hp-positive stages Ⅲ-Ⅳpatients than in stage Ⅰ-Ⅱ;and both PGI and PGR levels were lower in Hp-negative stages Ⅲ-Ⅳ patients than in stages Ⅰ-Ⅱ.In OLGIM staging,PGI and PGR levels were lower and PGII and G-17 levels were higher in OLGIM Ⅲ-Ⅳ compared with OLGIMⅠ-Ⅱ in both Hp-positive and Hp-negative patients,and were statistically significant between OLGIM Ⅰ-Ⅱ and Ⅲ-Ⅳ(all P<0.05).4)Risk factors in patients with chronic atrophic gastritis OLGA stage Ⅲ-Ⅳ were associated with PGI(P<0.001),PGR(P<0.001),G-17(P=0.040),Hp infection rate(P=0.001)and the family history ratio of gastrointestinal tumors(P=0.002),and low PGI and high Hp infection rate were OLGA stage Ⅲ-Ⅳ independent risk factors(both P<0.001).Age(P<0.001),gastric mucosal serum(PGs)levels(P<0.05),Hp infection rate(P<0.001),and the family history ratio of gastrointestinal tumors(P=0.001)were all risk factors for OLGIM Ⅲ-Ⅳ stage,and advanced age and low PGR were independent risk factors for the OLGIM Ⅲ-Ⅳ stage population.5)According to the results of retrospective follow-up,we found that all 8 patients who progressed to GC were male,with a mean age between 66.50±8.94 years old,and all were in OLGA stage Ⅲ-Ⅳ and OLGIM stage Ⅱ-Ⅲ.In addition,the mean duration of their progression to GC was 2.19±1.03 years.6)According to Hp status,the area under the curve(AUC)was found to be the largest among Hp-positive OLGA stage Ⅲ-Ⅳ patients diagnosed by PGI at 0.789(95%CI:0.730-0.850,P<0.001),with an optimal cut-off value of 115.23(sensitivity 82.8%and specificity 66.9%).The AUC of Hp-positive OLGIM stage Ⅲ-Ⅳ patients diagnosed by PGR was 0.758(95%CI:0.693-0.823,P<0.001),with an optimal cut-off value of 7.05(sensitivity 83.3%and specificity 61.2%).Conclusions Gastric mucosal serology combined with Hp provide clinical information about the overall condition of the gastric mucosa.Hp infection affects the levels of serologically relevant indicators(PGI,PGII,PGR,G-17).Hp and PGI are independent risk factors for OLGA stages Ⅲ-Ⅳ,age and PGR are independent risk factors for OLGIM stages Ⅲ-Ⅳ.OLGIM stage II masked the risk in Hp-positive individuals and they deserve attention.Finaliy,Hp combined with PGI and PGR was beneficial to screen the high-risk group for GC in OLGA and OLGIM Ⅲ-Ⅳ stages.