Association between gastric epithelial dysplasia and clinicopathological characteristics and overall survival in patients with metastatic gastric adenocarcinoma

Aims: Gastric epithelial dysplasia is a well-recognized precursor lesion in gastric carcinogenesis; however, the prognostic significance of documented dysplasia after the development of metastatic gastric adenocarcinoma remains uncertain. This study investigated the association between documented dysplasia, clinicopathological characteristics, and survival outcomes in patients with metastatic gastric adenocarcinoma. Methods: In this retrospective cohort study, consecutive patients with histopathologically confirmed metastatic gastric adenocarcinoma who received first-line systemic chemotherapy between January 2020 and December 2024 at a tertiary referral center were included. Clinicopathological characteristics, treatment data, laboratory findings, and survival outcomes were retrieved from institutional medical records. Overall survival (OS) was the primary endpoint, and OS and progression-free survival (PFS) were estimated using the Kaplan–Meier method. Prognostic factors for OS were evaluated using Cox proportional hazards regression. Results: A total of 67 patients were included (median age, 63.7 years; 77.6% male), of whom 21 (31.3%) had documented dysplasia. Median follow-up estimated using the reverse Kaplan–Meier method was 34.13 months (95% CI, 23.0–not estimable). Median PFS was 5.77 months (95% CI, 4.03–6.90), and median OS was 10.40 months (95% CI, 7.90–12.00). Patients with documented dysplasia had significantly shorter OS than those with no documented dysplasia (6.0 vs 10.9 months; log-rank p=0.012). In the forward-stepwise multivariable Cox regression model, higher ECOG performance status (HR 2.528, 95% CI 1.645–3.885; p<0.001) and documented dysplasia (HR 2.110, 95% CI 1.207–3.687; p=0.009) remained associated with poorer OS. Conclusion: In this retrospective cohort, documented dysplasia was associated with shorter OS and remained associated with poorer OS across the evaluated multivariable models. As a routinely recorded histopathological finding, documented dysplasia may warrant further investigation as a candidate prognostic marker. However, these findings remain exploratory and require validation in larger prospective multicenter studies incorporating standardized pathological assessment.