The significance of endoscopic Kyoto classification of gastritis in the gastric cancer risk assessment: A systematic review and meta‑analysis

Kyoto Classification of Gastritis is a newly proposed gastric cancer risk assessment in recent years. It selects important gastroscopic manifestations that have been reported and calculates score values. Although it has been extensively employed in clinical practice, there is no thorough review or systematic summary of its usage. METHODS: We looked for works published before May 2022 on the correlation between the Kyoto Classification of Gastritis and gastric cancer (GC) risk in Web of Science, EMBASE, China National Knowledge Infrastructure, PubMed, Wanfang database, and other suitable sources. Statistical analysis was carried out using Stata 14.0 and RevMan 5.40. Two statistical methods were employed. RESULTS: Eight case-control studies involving 6927 patients (continuous variables group: 1961 patients; dichotomy variables group: 4966 patients) were included, and the meta-analysis results showed a significant association between Kyoto Classification of Gastritis and GC. A Kyoto classification score ≥ 4 might indicate a risk of GC (odds ratios 7.30; 95% confidence intervals [CI] 3.62–14.72; P < .00001. There was a significant difference between gastritis and GC scores (mean difference [MD] 0.86; 95% CI 0.73–0.99; P < .00001). Moreover, we found that intestinal metaplasia and atrophy highly affected the Kyoto Classification score (MD = 0.35, MD = 0.72 95% CI 0.20–0.50,0.56–0.88). However, there was considerable heterogeneity in both statistical analyses. We found the source of heterogeneity in the first analysis method but failed to find it in the second analysis method, which may be due to the small number of studies. CONCLUSIONS: The Kyoto Classification of gastritis score is crucial for detecting early stomach cancer. A score >4 suggests a significant risk for gastric cancer, with atrophy and intestinal metaplasia having the most impact. This score may be promoted at primary hospitals; however, because of the small number and quality of included studies, the results mentioned above need to be verified by randomized control trials with large samples and high-quality methods.