Risk of progression to high-grade intraepithelial neoplasia and gastric cancer: A multi-center prospective study in Anhui Province, China.

Background: Gastric cancer is one of the most common cancers worldwide, especially in East Asia.

Aim: To explore the clinical outcomes and progression-related factors of low-grade intraepithelial neoplasia (LGIN) in the gastric mucosa and provide valuable guidance for improving treatment efficacy.

Methods: A total of 357 patients diagnosed with LGIN based on initial pathological examination in Anhui Provincial Hospital or three other medical consortium units between January 2022 and June 2024 were included. Among them, 296 patients were followed up with endoscopic and biopsy pathology. Logistic regression was utilized to analyze the relevant risk factors for LGIN progression in the gastric mucosa.

Results: The distribution sites of LGIN among the 357 patients were as follows: Gastric antrum (54.6%), gastric cardia (24.1%), gastric angulus (8.7%), gastric body (4.8%), gastric fundus (4.8%), and multiple sites (3.1%). Additionally, of the 357 patients with LGIN, 112 (31.4%) developed ulceration and 59 (16.5%) experienced gastric polyps. Furthermore, 231 of the 357 (64.71%) patients with LGIN tested positive for Helicobacter pylori (H. pylori) infection. The H. pylori infection rates of the patients with LGIN with accompanying atrophy, intestinal metaplasia, and gastric ulcer were 51.95%, 59.31%, and 28.57%, respectively. Multivariate logistic regression analysis showed that age ≥ 60 years [odds ratio (OR) = 3.063, 95% confidence interval (CI): 1.351-6.945, P = 0.007], H. pylori infection (OR = 3.560, 95%CI: 1.158-10.949, P = 0.027), multiple locations (OR = 10.136, 95%CI: 2.045-50.237, P = 0.005), lesion size ≥ 2 cm (OR = 3.921, 95%CI: 1.664-9.237, P = 0.002), and gastric ulcer (OR = 2.730, 95%CI: 1.197-6.223, P = 0.017) were predictive factors for LGIN progression.

Conclusion: LGIN progression is closely related to age, H. pylori positivity, multiple locations, lesion size ≥ 2 cm, and gastric ulcer. Thus, actively identifying these risk factors in patients with LGIN may have certain clinical significance in preventing further tumor progression.