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Background <p>Early detection of gastric cancer (GC) is crucial for improving prognosis. This study aimed to address the paucity of longitudinal evidence by validating and comparing the long-term predictive efficacy of the serology-based Li’s scoring system and the endoscopic Kyoto classification for GC risk stratification in a Chinese population.</p> Methods <p>This retrospective, single-center cohort study included 5801 patients who underwent esophagogastroduodenoscopy between April 2017 and December 2023. We conducted a cross-sectional analysis to evaluate the diagnostic accuracy of both systems using receiver operating characteristic (ROC) curves. A longitudinal analysis of 2836 patients with a median follow-up of 4.05 years was performed using Cox proportional hazards models and Kaplan-Meier curves to assess long-term predictive value for GC development.</p> Results <p>Cross-sectional evaluation revealed that the Kyoto classification outperformed Li’s scoring system in gastric cancer discrimination, yielding a significantly higher AUC (0.898, 95% CI: 0.859–0.938) than Li’s scoring system (0.760, 95% CI: 0.692–0.827), <i>P</i> = 0.011. These findings suggest that endoscopic-based assessment provides more precise initial risk stratification than serological scoring alone. The primary contribution of this study is the longitudinal analysis, which demonstrated that Li’s scoring system more effectively identified individuals at high long-term risk; the high-risk group had a significantly higher hazard ratio (HR) for developing GC compared to the low-risk group (HR = 4.27, 95% CI: 2.13–8.54, <i>P</i> &lt; 0.001). The annual GC incidence was markedly higher in the high-risk group defined by Li’s scoring system (2.29%) compared to that defined by the Kyoto classification (1.23%).</p> Conclusion <p>Both Li’s scoring system and the Kyoto classification are effective for gastric cancer risk assessment, yet they serve potentially complementary clinical roles. The Kyoto classification demonstrates significantly superior immediate discriminative power, while the serology-based Li’s scoring system shows promising prognostic value for longitudinal risk stratification, suggesting its potential utility as a preliminary non-invasive triage tool. However, further prospective multicenter validation studies and formal cost-effectiveness evaluations are needed before an integrated screening strategy can be recommended for large-scale population implementation.</p>

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Divergent roles of endoscopic Kyoto classification and serological Li’s scoring in immediate and long-term gastric cancer risk stratification: a 4-year longitudinal study

  • 期刊论文

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  • 发表日期：

    2026年6月1日

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  • Jiejun Lin,
  • Huang Su,
  • Jie Pan,
  • Leying Zhou,
  • Qingjie Zhou,
  • Junyan Du

摘要

Background

Early detection of gastric cancer (GC) is crucial for improving prognosis. This study aimed to address the paucity of longitudinal evidence by validating and comparing the long-term predictive efficacy of the serology-based Li’s scoring system and the endoscopic Kyoto classification for GC risk stratification in a Chinese population.

Methods

This retrospective, single-center cohort study included 5801 patients who underwent esophagogastroduodenoscopy between April 2017 and December 2023. We conducted a cross-sectional analysis to evaluate the diagnostic accuracy of both systems using receiver operating characteristic (ROC) curves. A longitudinal analysis of 2836 patients with a median follow-up of 4.05 years was performed using Cox proportional hazards models and Kaplan-Meier curves to assess long-term predictive value for GC development.

Results

Cross-sectional evaluation revealed that the Kyoto classification outperformed Li’s scoring system in gastric cancer discrimination, yielding a significantly higher AUC (0.898, 95% CI: 0.859–0.938) than Li’s scoring system (0.760, 95% CI: 0.692–0.827), P = 0.011. These findings suggest that endoscopic-based assessment provides more precise initial risk stratification than serological scoring alone. The primary contribution of this study is the longitudinal analysis, which demonstrated that Li’s scoring system more effectively identified individuals at high long-term risk; the high-risk group had a significantly higher hazard ratio (HR) for developing GC compared to the low-risk group (HR = 4.27, 95% CI: 2.13–8.54, P < 0.001). The annual GC incidence was markedly higher in the high-risk group defined by Li’s scoring system (2.29%) compared to that defined by the Kyoto classification (1.23%).

Conclusion

Both Li’s scoring system and the Kyoto classification are effective for gastric cancer risk assessment, yet they serve potentially complementary clinical roles. The Kyoto classification demonstrates significantly superior immediate discriminative power, while the serology-based Li’s scoring system shows promising prognostic value for longitudinal risk stratification, suggesting its potential utility as a preliminary non-invasive triage tool. However, further prospective multicenter validation studies and formal cost-effectiveness evaluations are needed before an integrated screening strategy can be recommended for large-scale population implementation.