The gastric precancerous conditions includes gastric mucosal atrophy and intestinal metaplasia, which is key link in the occurrence and development of gastric cancer, and its prevalence is on the rise in China. This paper details the conceptual difference between gastric precancerous conditions and precancerous lesions, identifies the evaluation methods of patients with high risk of carcinogenesis in gastric precancerous conditions from the aspects of endoscopy, pathological histology, and biomarkers, and summarizes the pathogenesis of gastric precancerous conditions. This paper shows that the cancer risk of gastric precancerous conditions is related to various factors such as the degree, range and subtype of lesions. In the microenvironment of gastric mucosa, imbalance and disorder of oxidation and antioxidant effect, energy metabolism, immune homeostasis, cell proliferation and death are the pathogenesis of gastric precancerous conditions. A comprehensive and prudent assessment of the cancer risk of gastric precancerous conditions is needed in clinical practice, thus providing patients with appropriate surveillance and follow-up programs to improve the detection rate of early gastric cancer. This paper can provide powerful evidence-based medical evidence for high-risk screening and prevention measures of gastric precancerous conditions in China, provide a reference for the in-depth development of mechanism research and new drug development.

胃癌前状态包括胃黏膜萎缩和肠化，是胃癌发生、发展过程中的关键环节，其患病率在我国呈上升趋势。本文详述了胃癌前状态和癌前病变在概念上的区别，从内镜下、病理组织学、生物标志物等层面识别胃癌前状态中癌变高风险患者的评估方法，总结了胃癌前状态的发病机制。本文表明胃癌前状态的癌变风险与病变的程度、范围、亚型等多种因素相关，胃黏膜微环境氧化与抗氧化作用、能量代谢、免疫稳态、细胞增殖与死亡等多个方面的失衡与紊乱是胃癌前状态的发病机制。临床需要综合谨慎评估胃癌前状态的癌变风险，从而为患者提供合适的监测和随访方案，提高早期胃癌的发现率。本文能够为我国胃癌前状态的高危筛查与防控措施提供有力的医学证据，并为机制研究与新药研发的深入开展提供借鉴。