Abstract:Objective To explore the value of the new gastric cancer screening scoring system, Kimura-Takemoto classification and operative link on gastritis assessment (OLGA) system in assessing the carcinogenesis risk stratification in chronic atrophic gastritis (CAG). Methods A total of 153 elderly patients who visited the outpatient department of Lu'an Hospital Affiliated to Anhui Medical University from December 2022 to April 2024 due to stomach discomfort were retrospectively selected. Three screening protocols were used to stratify the risk of CAG carcinogenesis: Kimura-Takemoto classification (grading the gastric mucosal atrophy and obtaining pathological specimens via endoscopy), new gastric cancer screening scoring system ［general condition, pepsinogen (PG) Ⅰ, PGⅡ, gastrin-17 andHelicobacter pylori antibody comprehensive score and grading］ and OLGA system (mucosal atrophy pathological staging). The correlation and consistency of the three in diagnosing CAG carcinogenesis risk stratification were analyzed, and their diagnostic value for the medium-to-high risk of CAG carcinogenesis were evaluated. Results Based on evaluations of Spearman and the intraclass correlation coefficient (ICC), the new gastric cancer screening scoring system and Kimura-Takemoto classification ( r =0.46,P ＜0.01; ICC=0.63, 95% CI : 0.49-0.73), the new gastric cancer screening scoring system and OLGA system ( r =0.45,P ＜0.01; ICC=0.62, 95% CI : 0.48-0.72), as well as the Kimura-Takemoto classification and OLGA system ( r =0.52,P ＜0.01; ICC=0.68, 95% CI : 0.56-0.77) exhibited moderate correlation and consistency in diagnosing CAG carcinogenesis risk stratification. According to the low risk, medium-to-high risk stratification by OLGA system, the results of ROC curve analysis showed that the area under curve (AUC) values of the new gastric cancer screening scoring system and the Kimura-Takemoto classification for the diagnosis of carcinogenesis medium- and high-risk of CAG were 0.78 and 0.75, respectively, and AUC of the two was the largest (0.81). Conclusion The new gastric cancer screening scoring system has an significant reference value for evaluating the carcinogenesis risk of CAG patients, and can reduce unnecessary invasive operations for low-risk patients. Pathological biopsy is the gold standard, and is recommended to further improve the gastroscopy and pathology examination in patients with middle to high risk.