A retrospective cohort study on the temporal evolution of gastric mucosal precancerous conditions
Chen Yifan
Zhang Hejun
Ding Shigang
Zhang Jing
Abstract：Objective To explore the temporal regularity of the progression of gastric mucosal precancerous conditions and optimize the endoscopic follow-up strategy for intestinal-type early gastric cancer screening.Methods A retrospective cohort study design was adopted in this study.Initially,5 655 patients with gastric mucosal lesions who underwent gastroscopy and pathological biopsy at the Digestive Endoscopy Center of Peking University Third Hospital from January 2005 to December 2024 were enrolled.A total of 659 patients with typical precancerous conditions before the following pathological endpoints[moderate dysplasia(MOD),severe dysplasia and intestinal-type early gastric cancer(SD/EGC)]were screened out,including 186 cases in the SD/EGC group and 473 cases in the MOD group.The temporal trajectory of the progression of precancerous conditions was analyzed based on endoscopic and pathological data.Results Among the 659 patients,the lesions were mainly distributed in the middle third of the stomach(299 cases,45.4％)and lower third(312 cases,47.3％),with the lesser curvature of the stomach(391 cases,59.3％)being the most common horizontal location.The detection rate of intestinal metaplasia(IM)in the background mucosa was 66.0％(435/659).The median time for chronic atrophic gastritis(CAG)to progress to moderate dysplasia(MOD)was 28(21,74)months(20 cases),and to severe dysplasia and intestinal-type early gastric cancer(SD/EGC)was 45(19,128)months(12 cases).The median progression times from IM,mild dysplasia(MD),and MOD to SD/EGC were 39(17,66)months(103 cases),38(18,75)months(97 cases),and 27(12,40)months(46 cases),respectively.Conclusion By analyzing the cascade progression sequence of CAG→IM→MD→MOD→ SD/EGC(arrows indicate progression to),this study confirmed that with the elevation of lesion grade,the time required for progression to the endpoint lesion generally shows a gradually shortening trend.Among them,the median time for MOD to progress to SD/EGC was 27 months.Combined with the recommendations of existing guidelines,it is considered that a high-definition chromoendoscopy follow-up strategy with an interval of at least 6-12 months should be adopted for MOD patients,thereby providing evidence-based basis for the early screening and intervention of intestinal-type gastric cancer based on the temporal trajectory of lesion progression.
Keywords：Gastric precancerous conditionsIntestinal-type early gastric cancerEndoscopic surveillanceProgression time
Publication Date：2025-12-18
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 1804-1808 )