Gastric Mucosal Status and Risk of Gastric Cancer in High-Risk Individuals: A Population-Based, Multicenter Prospective Study in China

ObjectiveThis study explored the distributions of gastric mucosal status and their links to gastric cancer within urban high-risk individuals in China.MethodsFrom 2014 to 2015, a questionnaire survey was administered among individuals aged 40 to 69 years, residing for over 3 years in seven selected cities across China. Utilizing the questionnaire data, high-risk individuals for gastric cancer were screened. These identified high-risk individuals were invited to undergo endoscopy, followed by pathological examinations conducted for those with suspicious lesions. Prior cancer patients and those newly diagnosed with gastric cancer were excluded, and the remaining endoscopic participants were prospectively followed up until December 2021.ResultsThe prospective study followed 8911 individuals at high risk of gastric cancer for a median duration of 6.77 years. The incidence density of gastric cancer was 58.55 per 100,000 person-years. At baseline, the distributions of subjects across normal gastric mucosa, gastritis/ulcer/polyp, atrophic gastritis/intestinal metaplasia, and intraepithelial neoplasia groups were 47.09%, 36.27%, 9.57%, and 7.07%, respectively. Compared with normal gastric mucosa, the hazard ratios (HRs) for gastric cancer in the other groups were 0.89 [95% confidence interval (95%CI): 0.38-2.08], 1.52 (95%CI: 0.50-4.66), and 4.63 (95%CI: 1.98-10.82). When using the 40-54 age group as the reference, the HR for 55-69 age group was 3.49 (95%CI: 1.52-7.98).ConclusionAmong high-risk individuals with gastric cancer, the proportions of individuals exhibiting different gastric mucosal status inversely correlated with the severity of mucosal lesions, whereas the risk of gastric cancer progressively escalated with the increasing severity of mucosal lesions and advancing age.