Metachronous gastric cancer（MGC）可能会在接受早期胃癌根治性内镜下黏膜切除术的患者中发展。由于胃炎和肠化生是胃癌的显着先兆，因此我们利用胃炎评估联合操作链（OLGA）和胃肠化生评估联合操作链（OLGIM）系统评估了MGC风险。本回顾性队列研究对2005年至2015年接受内镜下黏膜切除术治疗早期胃癌的916名患者进行了OLGA和OLGIM分期分类。对MGC的发展进行了随访，直到2020年，并使用Cox比例风险回归分析评估风险因素。 在中位随访94个月的期间，120名患者出现MGC。 多元分析中，OLGA分期II～IV明显与增加的MGC风险相关（风险比[HR]1.83，95％置信区间[CI] 1.05-3.19；HR 2.31，95％CI 1.22-4.38；HR 2.36，95％CI 1.16-4.78），即使调整了已知的幽门螺杆菌根除的阳性预测因子。 OLGIM分期II~IV也显示了显着的相关性（HR 2.86，95% CI 1.29-6.54；HR 2.94，95% CI 1.34-6.95；HR 3.64，95% CI1.60-8.29）。五年累积发病率随着每个阶段而增加。幽门螺杆菌根除的OLGIM分期0~II患者的MGC明显少于未根除的患者（4.5％vs 11.8％，P＝0.022），而OLGIM分期III~IV患者则未观察到这种趋势。高OLGA和OLGIM分期是后发性胃癌的独立风险因素，其中OLGIM分期系统是更好的预测因子。 OLGIM分期0~II的患者是可能从幽门螺杆菌根除中受益的亚组。©2023年。作者在国际胃癌协会和日本胃癌协会的独家许可下发表。

Metachronous gastric cancer (MGC) may develop in patients undergoing curative endoscopic submucosal dissection for early gastric cancer. As gastritis and intestinal metaplasia are notable precursors to gastric cancer, we assessed MGC risk using the Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia assessment (OLGIM) systems.This retrospective cohort study classified the OLGA and OLGIM stages for 916 patients who had undergone endoscopic submucosal dissection for early gastric cancer between 2005 and 2015. MGC development was followed up until 2020 and risk factors were evaluated using the Cox proportional hazards regression analysis.During a median follow-up of 94 months, MGC developed in 120 subjects. OLGA stages II ~ IV were significantly associated with increased MGC risk (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.05-3.19; HR 2.31, 95% CI 1.22-4.38; HR 2.36, 95% CI 1.16-4.78) in multivariable analysis, even after adjusting for the well-known positive predictor of Helicobacter pylori eradication. OLGIM stages II ~ IV also showed significant association (HR 2.86, 95% CI 1.29-6.54; HR 2.94, 95% CI 1.34-6.95; HR 3.64, 95% CI 1.60-8.29). 5-year cumulative incidence increased with each stage. Helicobacter pylori-eradicated patients with OLGIM stages 0 ~ II had significantly less MGC than non-eradicated patients (4.5% vs 11.8%, p = 0.022), which was not observed with OLGIM stages III ~ IV.High OLGA and OLGIM stages are independent risk factors for metachronous gastric cancer, with the OLGIM staging system being a better predictor. Patients with OLGIM stages 0 ~ II are a subgroup that may benefit more from Helicobacter pylori eradication.© 2023. The Author(s) under exclusive licence to The International Gastric Cancer Association and The Japanese Gastric Cancer Association.