Validation of the ABC Method for Gastric Cancer Risk Stratification Across Helicobacter pylori Infections With Diverse CagA Status and Subtypes in Brazil.
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Maruta Luis Masuo, Furukawa Asuka, Seidler Heinrich Bender Kohnert, Felipe-Silva Aloisio, Uchida Keisuke, Kobayashi Daisuke, Yamamoto Kurara, Minami Junko, Sekine Masaki, Takagi Minako, Hassegawa Renato Takayuki, Ogawa Eduardo Koji Marchi, Villaça Rodrigo Barbosa, de Araujo Couto Tecio, Biasuz Jorge Alberto Capra, Tafner Edmar, Werneck-Silva Ana Luiza, Pilli Simone Perez, da Silva José Guilherme Nogueira, da Silva Leonard Medeiros, Fock Ricardo Ambrosio, Ogura Chinatsu, Mizuguchi Yumi, Miura Keiko, Yamamoto Kouhei, Eishi Yoshinobu, Ohashi Kenichi
Аннотация
MATERIALS AND METHODS: This prospective study in Brazil evaluated the performance of the ABC method in an endoscopy-referred cohort with a heterogeneous distribution of Hp CagA status and subtypes. A recently validated immunohistochemical method was applied to formalin-fixed paraffin-embedded gastric biopsy samples to assess Hp infection, CagA expression, and CagA subtypes. Gastric pathology was evaluated using the updated Sydney System and OLGA/OLGIM staging and correlated with serum Hp antibody and pepsinogen levels in 586 patients, including 122 Japanese Brazilians.
RESULTS: Immunohistochemistry achieved a 98% success rate (577/586). The prevalence of Hp infection was 48%, with Western-type CagA(+) (26%) and CagA(-) (18%) strains predominating. East Asian-type CagA(+) strains (4%) were observed primarily among Japanese Brazilians, particularly in second-generation individuals. Gastric pathology and serum markers differed significantly across CagA status and subtypes. Despite these differences, the ABC method's negative predictive values (NPVs) across all groups other than Group A (negative for both tests) remained high (97%/97% or 98%/100% for detecting OLGA/OLGIM stages ≥ II or ≥ III, and 94%/98% or 99%/100% for detecting antrum/corpus inflammation scores ≥ 2 or 3, respectively).
CONCLUSIONS: These findings demonstrate the clinical relevance of CagA diversity for gastric cancer risk assessment. Although limited to an endoscopy-referred cohort, the ABC method reliably identified low-risk individuals (Group A) and may help reduce unnecessary endoscopies in screening programs, regardless of CagA status and subtypes. Broader, population-based studies are needed to validate its generalizability and optimize its implementation.