{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:56:22Z","timestamp":1787165782833,"version":"build-2736575974"},"reference-count":56,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100007951","name":"Tokyo Medical and Dental University","doi-asserted-by":"publisher","award":["11AA100346"],"award-info":[{"award-number":["11AA100346"]}],"id":[{"id":"10.13039\/501100007951","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007951","name":"Tokyo Medical and Dental University","doi-asserted-by":"publisher","award":["91AA191536"],"award-info":[{"award-number":["91AA191536"]}],"id":[{"id":"10.13039\/501100007951","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Gastric 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\n \n Helicobacter pylori<\/jats:italic>\n <\/jats:styled-content>\n (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.\n <\/jats:p>\n <\/jats:sec>\n \n Materials and Methods<\/jats:title>\n This prospective study in Brazil evaluated the performance of the ABC method in an endoscopy\u2010referred cohort with a heterogeneous distribution of Hp CagA status and subtypes. A recently validated immunohistochemical method was applied to formalin\u2010fixed paraffin\u2010embedded 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Immunohistochemistry achieved a 98% success rate (577\/586). The prevalence of Hp infection was 48%, with Western\u2010type CagA(+) (26%) and CagA(\u2212) (18%) strains predominating. East Asian\u2010type CagA(+) strains (4%) were observed primarily among Japanese Brazilians, particularly in second\u2010generation 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 \u2265\u2009II or \u2265\u2009III, and 94%\/98% or 99%\/100% for detecting antrum\/corpus inflammation scores \u2265\u20092 or 3, respectively).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n These findings demonstrate the clinical relevance of CagA diversity for gastric cancer risk assessment. Although limited to an endoscopy\u2010referred cohort, the ABC method reliably identified low\u2010risk individuals (Group A) and may help reduce unnecessary endoscopies in screening programs, regardless of CagA status and subtypes. Broader, population\u2010based studies are needed to validate its generalizability and optimize its implementation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/cam4.71016","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T05:55:22Z","timestamp":1751003722000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Validation of the\n ABC<\/scp>\n Method for Gastric Cancer Risk Stratification Across\n Helicobacter pylori<\/i>\n Infections With Diverse CagA Status and Subtypes in Brazil"],"prefix":"10.1002","volume":"14","author":[{"given":"Luis Masuo","family":"Maruta","sequence":"first","affiliation":[{"name":"Hospital Universit\u00e1rio, Endoscopy Service Universidade de S\u00e3o Paulo (USP) S\u00e3o Paulo SP Brazil"},{"name":"Hospital Japon\u00eas Santa Cruz S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asuka","family":"Furukawa","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Graduate School of Medical and Dental Sciences Institute of Science Tokyo (Formerly Known as Tokyo Medical and Dental University) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinrich Bender Kohnert","family":"Seidler","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio Brasiliense Bras\u00edlia Distrito Federal Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aloisio","family":"Felipe\u2010Silva","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio, Anatomic Pathology Service Universidade de S\u00e3o Paulo (USP) S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Uchida","sequence":"additional","affiliation":[{"name":"Division of Surgical Pathology Institute of Science Tokyo Hospital (Formerly Known as Tokyo Medical and Dental University Hospital) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Graduate School of Medical and Dental Sciences Institute of Science Tokyo (Formerly Known as Tokyo Medical and Dental University) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurara","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Graduate School of Medical and Dental Sciences Institute of Science Tokyo (Formerly Known as Tokyo Medical and Dental University) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junko","family":"Minami","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Graduate School of Medical and Dental Sciences Institute of Science Tokyo (Formerly Known as Tokyo Medical and Dental University) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Sekine","sequence":"additional","affiliation":[{"name":"Division of Surgical Pathology Institute of Science Tokyo Hospital (Formerly Known as Tokyo Medical and Dental University Hospital) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minako","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Graduate School of Medical and Dental Sciences Institute of Science Tokyo (Formerly Known as Tokyo Medical and Dental University) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato Takayuki","family":"Hassegawa","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio, Endoscopy Service Universidade de S\u00e3o Paulo (USP) S\u00e3o Paulo SP Brazil"},{"name":"Hospital Japon\u00eas Santa Cruz S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo Koji Marchi","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Hospital Japon\u00eas Santa Cruz S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo Barbosa","family":"Villa\u00e7a","sequence":"additional","affiliation":[{"name":"Clinica Bras\u00edlia Bras\u00edlia Distrito Federal Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tecio","family":"de Araujo Couto","sequence":"additional","affiliation":[{"name":"Clinica Bras\u00edlia Bras\u00edlia Distrito Federal Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Alberto Capra","family":"Biasuz","sequence":"additional","affiliation":[{"name":"Clinica Bras\u00edlia Bras\u00edlia Distrito Federal Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmar","family":"Tafner","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio, Endoscopy Service Universidade de S\u00e3o Paulo (USP) S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Luiza","family":"Werneck\u2010Silva","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio, Endoscopy Service Universidade de S\u00e3o Paulo (USP) S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone Perez","family":"Pilli","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio, Endoscopy Service Universidade de S\u00e3o Paulo (USP) S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Guilherme Nogueira","family":"da Silva","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio, Endoscopy Service Universidade de S\u00e3o Paulo (USP) S\u00e3o Paulo SP Brazil"},{"name":"Hospital Japon\u00eas Santa Cruz S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard Medeiros","family":"da Silva","sequence":"additional","affiliation":[{"name":"Hospital Japon\u00eas Santa Cruz S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo Ambrosio","family":"Fock","sequence":"additional","affiliation":[{"name":"Faculty of Pharmaceutical Sciences Universidade de S\u00e3o Paulo (USP) S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinatsu","family":"Ogura","sequence":"additional","affiliation":[{"name":"Division of Surgical Pathology Institute of Science Tokyo Hospital (Formerly Known as Tokyo Medical and Dental University Hospital) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumi","family":"Mizuguchi","sequence":"additional","affiliation":[{"name":"Division of Surgical Pathology Institute of Science Tokyo Hospital (Formerly Known as Tokyo Medical and Dental University Hospital) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiko","family":"Miura","sequence":"additional","affiliation":[{"name":"Division of Surgical Pathology Institute of Science Tokyo Hospital (Formerly Known as Tokyo Medical and Dental University Hospital) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kouhei","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Graduate School of Medical and Dental Sciences Institute of Science Tokyo (Formerly Known as Tokyo Medical and Dental University) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0521-1670","authenticated-orcid":false,"given":"Yoshinobu","family":"Eishi","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Graduate School of Medical and Dental Sciences Institute of Science Tokyo (Formerly Known as Tokyo Medical and Dental University) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Ohashi","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Graduate School of Medical and Dental Sciences Institute of Science Tokyo (Formerly Known as Tokyo Medical and Dental University) Tokyo Japan"},{"name":"Division of Surgical Pathology Institute of Science Tokyo Hospital (Formerly Known as Tokyo Medical and Dental University Hospital) Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.33588"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(17)33326\u20103"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(08)70072\u2010X"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.2183\/pjab.87.405"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1159\/000441742"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523\u20105378.2010.00799.x"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10198\u2010017\u20100901\u2010y"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102024\u2010332705"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15030664"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0007736"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/418063"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365521.2011.598549"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2007.06.026"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMOA001999"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/1371089"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478\u2010199610000\u201000001"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2008.02.030"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.12.029"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876\u2010015\u20100327\u2010x"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41423\u2010019\u20100339\u20105"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0197695"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25031761"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/TOXINS10040163"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365529108996244"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102036.1995.tb00426.x"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.44.3.336"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1086\/381782"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/NRC1433"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.CHOM.2014.02.008"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1073\/PNAS.222375399"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1126\/SCIENCE.1067147"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1086\/345374"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/S13099\u2010017\u20100205\u2010X"},{"issue":"1","key":"e_1_2_11_36_1","first-page":"105","article-title":"Prevalence of cagA EPIYA Motifs in Helicobacter pylori Among Dyspeptic Patients in Northeast Thailand","volume":"43","author":"Chomvarin C.","year":"2012","journal-title":"Southeast Asian Journal of Tropical Medicine and Public Health"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/S42770\u2010020\u201000292\u20103"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1128\/JB.06340\u201011"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.05562\u201011"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/S00535\u2010006\u20101838\u20106"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.03.041"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102559.2012.04190.x"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12866\u2010024\u201003619\u20104"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0031020"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2013.00328"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00011\u201010"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1373\/CLINCHEM.2014.223040"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.3390\/V14010133"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PONE.0265441"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(19)33596-6"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(19)33138-5"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(82)90176-7"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1055\/a\u20100859\u20101883"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1590\/s0004\u20102803.202100000\u201008"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1590\/s0004\u20102803.202000000\u201029"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876\u2010022\u201002381\u2010z"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl18399"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.71016","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cam4.71016","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.71016","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T07:16:49Z","timestamp":1778915809000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.71016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,27]]},"references-count":56,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1002\/cam4.71016"],"URL":"https:\/\/doi.org\/10.1002\/cam4.71016","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"value":"2045-7634","type":"print"},{"value":"2045-7634","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,27]]},"assertion":[{"value":"2024-06-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71016"}}