ArticleCancer medicine2025
Validation of the ABC Method for Gastric Cancer Risk Stratification Across Helicobacter pylori Infections With Diverse CagA Status and Subtypes in Brazil.
Article in Cancer medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Prevention of Gastric Cancer.Medicina (Kaunas, Lithuania) · 2026Review
- Serology and magnetically controlled capsule gastroscopy for opportunistic screening of high-risk events in gastric cancer development: a cross-sectional study.Frontiers in medicine · 2026Article
- VTH BRAZILIAN CONSENSUS CONFERENCE ON HELICOBACTER PYLORI INFECTION.Arquivos de gastroenterologia · 2026Article
- An Opportunistic Screening Strategy for Gastric Cancer Based on Questionnaire and Sequential Serology: A Hospital-Based Cross-Sectional Study (SIGES).Journal of clinical medicine · 2025Article
- Validation of the ABC Method for Gastric Cancer Risk Stratification Across Helicobacter pylori Infections With Diverse CagA Status and Subtypes in Brazil.Cancer medicine · 2025Article
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Abstract
backgroundGastric cancer survival rates vary across countries due to differences in access to early diagnostic testing and healthcare quality. Endoscopy, though accurate, is not feasible for mass screening. The ABC method, which combines serum Helicobacter pylori (Hp) antibody and pepsinogen tests, has shown promise for gastric cancer risk stratification in Japan. However, its applicability in populations with diverse CagA status and subtypes remains uncertain. MATERIALS AND
methodsThis 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.
resultsImmunohistochemistry 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).
conclusionsThese 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.
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