AIM：To compare the reliability of gastritis staging sys-tems in ranking gastritis-associated cancer risk in a large series of consecutive patients.METHODS：Gastric mucosal atrophy is the precancer-ous condition in which intestinal-type gastric cancer（GC）most frequently develops.The operative link for gas-tritis assessment（OLGA）staging system ranks the GC risk according to both the topography and the severity of gastric atrophy（as assessed histologically on the ba-sis of the Sydney protocol for gastric mucosal biopsy）.Both cross-sectional and long-term follow-up trials have consistently associated OLGA stages Ⅲ-Ⅳ with a higher risk of GC.A recently-proposed modification of the OLGA staging system（OLGIM）basically incorporates the OLGA frame,but replaces the atrophy score with an assessment of intestinal metaplasia（IM）alone.A series of 4552 consecutive biopsy sets（2007-2009）was re-trieved and reassessed according to both the OLGA and the OLGIM staging systems.A set of at least 5 biopsy samples was available for all the cases considered.RESULTS：In 4460 of 4552 cases（98.0%）,both the high-risk stages（Ⅲ ＋ Ⅳ）and the low-risk stages（0 ＋Ⅰ ＋ Ⅱ）were assessed applying the OLGA and OL-GIM criteria.Among the 243 OLGA high-risk stages,14（5.8%）were down-staged to a low risk using OLGIM.The 67（1.5%）incidentally-found neoplastic lesions（intraepithelial or invasive）were consistently associated with high-risk stages,as assessed by both OLGA and OLGIM（P 〈 0.001 for both）.Two of 34 intestinal-type GCs coexisting with a high-risk OLGA stage（stage Ⅲ）were associated with a low-risk OLGIM stage（stage Ⅱ）.CONCLUSION：Gastritis staging systems（both OLGA and OLGIM）convey prognostically important informa-tion on the gastritis-associated cancer risk.Because of its clinical impact,the stage of gastritis should be included as a conclusive message in the gastritis histol-ogy report.Since it focuses on IM alone,OLGIM staging is less sensitive than OLGA staging in the identif ication of patients at high risk of gastric cancer.