Risk factors for gastric intraepithelial neoplasia in Chinese adults: a case-control study

Gastric carcinoma (GC) is the third most frequent malignancy and the second most common cancer-related cause of death cause worldwide. Gastric intraepithelial neoplasia (GIN) is a well-documented precancerous lesion of GC. In this case-control study, we comprehensively explored the clinical and pathological characteristics of GIN, with the aim to identify its potential risk factors.

A total of 630 consecutive patients who underwent endoscopic submucosal dissection or mucosal resection for GIN were initially included. The detailed characteristics of all eligible patients and well-matched healthy controls were recorded and analyzed. Both univariate and multivariate logistic regression analyses were performed and presented with odds ratio (OR) and 95% confidential interval (CI), with additional subgroup analyses based on lesion location.

A total of 485 GIN-eligible patients were selected, among which 156 had proximal GIN. After follow-up, 434 patients with GIN and 310 age- and gender-matched healthy controls were included in the comparative analyses. Family cancer history (FCH); alcohol abuse; tobacco abuse; intake of high sodium, preserved food, spicy food, and less fruit; Helicobacter pylori (Hp) infection; and atrophic gastritis with intestinal metaplasia were more frequent in GIN patients. Thus, FCH (OR =3.485, 95% CI: 2.031-5.981), high sodium intake (OR =2.830, 95% CI: 1.645-4.868), less fruit intake (OR =4.082, 95% CI: 2.515-6.625), Hp infection (OR =2.307, 95% CI: 1.417-3.755), and atrophic gastritis with intestinal metaplasia (OR =15.070, 95% CI: 8.999-25.237) were independent risk factors for GIN. Further subgroup analyses demonstrated that the specific independent risk factor for proximal GIN was age (OR =2.001, 95% CI: 1.003-3.994), whereas that for distal GIN was intake of high sodium (OR =3.467, 95% CI: 1.896-6.338).

This study reported a comprehensive overview of the clinical and pathological characteristics of GIN. FCH, high sodium intake, less fruit intake, Hp infection, and atrophic gastritis were identified as the independent risk factors for GIN.