Helicobacter pylori Infection Combined with OLGA and OLGIM Staging Systems for Risk Assessment of Gastric Cancer: A Retrospective Study in Eastern China

Figures & data

Figure 1 A flow chart for screening the study subjects was established.

Table 1 Baseline Characteristics of Patients with Atrophic Gastritis in This Study

	GA (n = 609)		GIM (n = 527)
Age, years, mean (SD)	51.13 (9.95)		50.83 (9.95)
BMI, kg/m², mean (SD)	24.28 (2.92)		24.06 (3.27)
Gender, Male, n (%)	359 (58.95)		283 (53.70)
Smoking, n (%)	253 (41.54)		225 (42.69)
Alcohol consumption, n (%)	262 (43.02)		239 (45.35)
Family history, n (%)	60 (9.85)		58 (11.01)
H. pylori infection, n (%)	259 (42.53)		205 (38.90)
	OLGA stage I, n (%)	184 (30.21)	OLGIM stage I, n (%)	192 (36.43)
	OLGA stage II, n (%)	264 (43.35)	OLGIM stage II, n (%)	178 (33.78)
	OLGA stage III, n (%)	99 (16.26)	OLGIM stage III, n (%)	112 (21.25)
	OLGA stage IV, n (%)	62 (10.18)	OLGIM stage IV, n (%)	45 (8.54)

Abbreviations: GA, gastric atrophy; GIM, gastric intestinal metaplasia; BMI, body mass index; SD, standard deviation; OLGA, operative link on gastritis assessment; OLGIM, operative link on gastric intestinal metaplasia assessment.

Table 2 Serum PGs/G-17 Levels and Population Characteristics in OLGA/OLGIM Stage

	OLGA					OLGIM
	Stage I (n = 184)	Stage II (n = 264)	Stage III (n = 99)	Stage IV (n = 62)	p-value	Stag I (n = 192)	Stage II (n = 178)	Stage III (n = 112)	Stage IV (n = 45)	p-value
PGI, µg/L Median (IQR)	120.59 (83.78–168.36)	101.72 (78.03–130.07)	100.02 (76.40–110.15)	58.70 (46.18–72.31)	< 0.001	103.42 (81.46–134.43)	101.15 (75.56–128.03)	89.50 (63.87–127.26)	71.12 (54.85–107.52)	0.001
PGII, µg/L Median (IQR)	11.50 (6.67–21.33)	9.56 (6.49–15.83)	9.92 (6.45–14.73)	9.93 (6.09–14.76)	0.060	7.58 (5.32–11.77)	9.84 (6.67–17.17)	12.29 (7.10–20.43)	14.15 (9.62–20.62)	< 0.001
PGR, Median (IQR)	10.53 (7.65–13.48)	10.60 (7.10–14.01)	9.43 (6.67–14.16)	6.26 (4.02–10.71)	< 0.001	13.70 (10.58–16.29)	10.13 (7.09–12.59)	7.65 (5.90–9.85)	4.61 (2.66–6.36)	< 0.001
G-17, pmol/L Median (IQR)	3.01 (1.34–7.70)	2.48 (1.33–6.56)	2.33 (1.29–5.89)	4.75 (2.54–29.24)	< 0.001	2.08 (1.16–5.13)	3.10 (1.33–6.46)	3.10 (1.69–10.33)	8.28 (3.61–36.38)	< 0.001
Age, years, mean (SD)	51.41 (9.48)	51.10 (9.99)	50.32 (9.15)	52.52 (11.67)	0.369	49.63 (9.03)	49.96 (10.09)	53.52 (10.70)	52.60 (10.01)	0.003
BMI, kg/m², mean (SD)	24.56 (2.95)	24.18(3.03)	24.27 (2.98)	23.95 (3.26)	0.469	24.26 (3.15)	23.89 (3.41)	24.13 (3.31)	23.62 (3.36)	0.595
H. pylori infection, n (%)	68 (36.96)	104(39.40)	48 (48.48)	39 (62.90)	0.002	50 (26.04)	71 (39.89)	52 (46.43)	32 (71.11)	< 0.001
Smoking, n (%)	80 (43.48)	105 (39.78)	45 (45.45)	23 (37.10)	0.625	83 (43.23)	78 (43.82)	52 (46.43)	12 (26.67)	0.140
Alcohol consumption, n (%)	83 (45.11)	108 (40.91)	44 (44.44)	27 (43.55)	0.826	85 (44.27)	85 (47.75)	55 (49.11)	14 (31.11)	0.185
Family history, n (%)	16 (8.70)	18 (6.82)	7 (7.07)	19 (30.65)	< 0.001	16 (8.33)	14 (7.87)	18 (16.07)	10 (22.22)	0.008
Gender, Male, n (%)	122 (66.30)	143 (54.17)	61 (61.61)	33 (53.23)	0.052	109 (56.77)	91 (51.12)	65 (58.04)	18 (40.00)	0.142

Abbreviations: PGI, serum pepsinogen I; PGII, serum pepsinogen II; PGR, pepsinogen I and II ratio; G-17, gastrin-17; BMI, body mass index; SD, standard deviation; IQR, interquartile range.

Table 3 Serum PGs/G-17 in OLGA/OLGIM Stages I–II and III–IV

		OLGA				OLGIM
		PGI, µg/L Median (IQR)	PGII, µg/L Median (IQR)	PGR, Median (IQR)	G-17, pmol/L Median (IQR)	PGI, µg/L Median (IQR)	PGII, µg/L Median (IQR)	PGR, Median (IQR)	G-17, pmol/L Median (IQR)
H. pylori-Positive	Stages I–II	136.09(107.43–164.03)	19.81(12.68–24.38)	7.08(5.60–9.43)	6.81(4.28–14.06)	114.52(99.52–153.44)	14.74(11.26–22.52)	7.96 (5.91–12.77)	6.02(3.18–10.01)
	Stages III–IV	89.00(70.85–111.90)	13.41(9.08–18.81)	6.69(5.08–8.90)	5.13(2.48–11.31)	108.98(67.23–141.50)	17.80(13.84–24.72)	5.68(4.46–6.66)	6.48(4.14–19.02)
p-value		<0.001	<0.001	0.252	0.075	0.018	0.015	<0.001	0.030
H. pylori-Negative	Stages I–II	90.12(73.67–121.54)	7.29(5.66–10.46)	12.7(10.27–14.83)	1.70(1.08–3.26)	90.36(71.42–118.56)	6.92(5.02–9.46)	13.20(11.11–15.95)	1.61(1.08–3.22)
	Stages III–IV	74.92(54.23–111.66)	6.55(4.85–9.96)	11.28(7.40–15.78)	1.71(1.20–4.03)	70.70(59.13–93.19)	7.55(6.02–11.74)	9.00(6.94–11.10)	2.10(1.30–6.66)
p-value		<0.001	0.132	0.009	0.308	<0.001	0.006	<0.001	0.008
Stages I–II	H. pylori-negative	90.12 (90.12–73.67)	7.29 (5.66–10.46)	12.70 (10.27–14.83)	1.70(1.08–3.26)	90.36(71.42–118.56)	6.92(5.02–9.46)	13.20(11.11–15.95)	1.61(1.08–3.22)
	H. pylori-positive	136.09(107.43–164.03)	19.81(12.68–24.38)	7.08(5.60–9.43)	6.81(4.28–14.06)	114.52(99.25–153.44)	14.74(11.26–22.52)	7.96(5.91–10.01)	6.02(3.18–10.01)
p-value		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
Stages III–IV	H. pylori-negative	74.92(54.23–101.95)	6.55(4.85–9.96)	11.28(7.40–15.78)	1.71(1.20–4.03)	70.70(59.13–93.19)	7.55(6.02–11.74)	9.00(6.94–11.10)	2.10(1.30–6.66)
	H. pylori-positive	89.00(70.85–111.90)	13.41(9.08–28.88)	6.69(5.08–8.90)	5.13(2.48–11.31)	108.98(67.23–141.50)	17.80(13.84–24.72)	5.68(4.46–6.66)	6.48(4.14–19.02)
p-value		0.002	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

Abbreviations: PGI, serum pepsinogen I; PGII, serum pepsinogen II; PGR, pepsinogen I and II ratio; IQR, interquartile range; G-17, gastrin-17.

Table 4 Univariate Logistic Regression Analysis of Risk Factors for Patients with OLGA/OLGIM III–IV

Risk factors	OLGA I–II VS OLGA III–IV				OLGIM I–II VS OLGIM III–IV
	OLGA I–II (n = 448)	OLGA III–IV (n = 161)	p-value	OR (95% CI)	OLGIM I–II (n = 370)	OLGIM III–IV (n = 157)	p-value	OR (95% CI)
Gender, Male, n (%)	265 (59.15)	94 (58.39)	0.865	0.969 (0.672–1.397)	200 (54.05)	83 (52.87)	0.803	0.953 (0.658–1.386)
Age, years, mean (SD)	51.33 (9.78)	51.10 (10.30)	0.798	0.998 (0.980–1.016)	49.79 (9.58)	53.29 (10.39)	<0.001	1.036 (1.017–1.057)
BMI, kg/m², mean (SD)	24.32 (2.92)	24.16 (2.90)	0.545	0.981 (0.922–1.044)	24.09 (3.27)	23.97 (3.28)	0.712	0.989 (0.934–1.048)
Smoking, n (%)	185 (41.29)	68 (42.24)	0.835	1.039 (0.722–1.497)	161 (43.51)	64 (40.76)	0.560	0.893 (0.612–1.305)
Alcohol consumption, n (%)	191 (42.63)	71 (44.10)	0.747	1.061 (0.738–1.526)	170 (45.95)	69 (43.95)	0.674	0.922 (0.634–1.343)
Family history, n (%)	34 (7.59)	26 (16.15)	0.002	2.345 (1.358–4.050)	30 (8.11)	28 (17.83)	0.001	2.460 (1.414–4.279)
H. pylori infection, n (%)	172 (38.39)	87 (54.04)	0.001	1.887 (1.311–2.714)	121 (32.70)	84 (53.50)	<0.001	2.368 (1.617–3.468)
PGI, µg/L Median (IQR)	107.05 (79.49–141.21)	79.53 (64.36–107.90)	<0.001	0.986 (0.981–0.990)	101.97 (78.42–132.98)	85.31 (62.33–122.29)	0.019	0.995 (0.992–0.999)
PGII, µg/L Median (IQR)	10.35 (6.57–17.80)	9.92 (6.45–14.73)	0.283	0.989 (0.970–1.009)	8.50 (6.01–13.04)	13.84 (7.68–20.81)	<0.001	1.055 (1.034–1.076)
PGR, Median (IQR)	10.58 (7.34–17.02)	8.01 (5.86–12.64)	<0.001	0.925 (0.888–0.964)	11.89 (8.73–14.87)	6.67 (4.98–9.13)	<0.001	0.739 (0.695–0.787)
G-17, pmol/L Median (IQR)	2.85 (1.33–7.05)	3.06 (1.54–9.52)	0.040	1.015 (1.001–1.029)	2.37 (1.28–5.89)	4.32 (2.06–14.38)	<0.001	1.062 (1.040–1.085)

Abbreviations: PGI, serum pepsinogen I; PGII, serum pepsinogen II; PGR, pepsinogen I and II ratio; G-17, gastrin-17; BMI, body mass index; SD, standard deviation; IQR, interquartile range.

Table 5 Multivariate Logistic Regression Analysis of Risk Factors for Patients with OLGA/OLGIM III–IV

Risk Factors	OLGA stages III–IV		OLGIM Stages III–IV
	p-value	OR (95% CI)	p-value	OR (95% CI)
Age	-	-	0.027	1.026 (1.003–1.050)
PGI	0.001	0.982 (0.976–0.988)	0.238	0.994 (0.985–1.004)
PGII	-	-	0.825	1.007 (0.948–1.070)
PGR	0.399	0.977 (0.925–1.031)	<0.001	0.726 (0.641–0.824)
G-17	0.605	0.995 (0.978–1.013)	0.402	1.011 (0.985–1.037)
H. pylori infection	<0.001	2.916 (1.796–4.736)	0.059	0.572 (0.320–1.021)
Family history	0.166	1.536 (0.837–2.821)	0.126	1.704 (0.861–3.372)

Abbreviations: PGI, serum pepsinogen I; PGII, serum pepsinogen II; PGR, pepsinogen I and II ratio; G-17, gastrin-17.

Table 6 Characteristics of Eight Patients with GC

Gender	Age (y)	H. Pylori Infection	Treatment of H. Pylori	OLAG Stage	OLGIM Stage	The Lesion Location	The Lesion Type	Follow-up Time	Smoking	Alcohol Consumption	Family History
Male	69	Positive	Failed	III	II	Corpus	HGIN	1.5 years	N	N	N
Male	65	Negative	-	III	III	Antrum	HGIN	1 year	Y	Y	N
Male	68	Negative	-	IV	III	Corpus	Adenocarcinom	3 years	Y	Y	N
Male	55	Negative	-	III	II	Corpus	HGIN	2.5 years	Y	N	Y
Male	58	Positive	Failed	III	II	Antrum	HGIN	4 years	Y	N	N
Male	83	Negative	-	III	III	Antrum	HGIN	2.5 years	N	Y	N
Male	73	Positive	Failed	III	II	Antrum	HGIN	2 years	N	N	Y
Male	61	Positive	Failed	III	III	Corpus	Adenocarcinoma	1 year	Y	Y	N

Notes: Y, patient with a history of smoking, patient with a history of alcohol consumption, patient with family history of gastrointestinal tumors. N, patient without a history of smoking, patient without a history of alcohol consumption, patient without family history of gastrointestinal tumors.

Abbreviation: HGIN, high grade intraepithelial neoplasia.

Figure 2 (A) ROC curves of PGI for the diagnosis of OLGA stages III–IV of atrophic gastritis (the green line is patients with H. pylori-positive; the blue line is patients with H. pylori-negative; the red line is all patients with GA). (B) ROC curves of PGR for the diagnosis of OLGIM stages III–IV of atrophic gastritis (the green line is patients with H. pylori-positive; the blue line is patients with H. pylori-negative; the red line is all patients with GIM).

Abbreviation: AUC, area under the curve.