The prevalence of precursor lesions for gastric cancer (GC) and the differential burden between countries of varying GC risk is not well-understood. We conducted a systematic review and meta-analysis to estimate the global prevalence of precursor lesions. We estimated the prevalence of atrophic gastritis (AG), gastric intestinal metaplasia (IM), and dysplasia in regions with low, medium, and high GC incidence. Because IM is an advanced manifestation of AG, we assessed the prevalence of less advanced precursors, regardless of the presence of more advanced lesions. Prevalence was sub-stratified by infection, symptomatology, and period (<2000, 2000–2010, and >2010). Among the 582 articles that underwent full-text review, 166 studies met inclusion criteria. The global prevalence estimates of AG, IM, and dysplasia were 25.4%, 16.2%, and 2.0%, respectively, on the basis of 126 studies that reported the prevalence of less advanced precursors, regardless of the presence of more advanced lesions. The prevalence of all precursor lesions was higher in high and medium compared with low GC incidence countries ( < .01). Prevalence of AG and IM was significantly higher among –infected individuals ( < .01) but not statistically different between symptomatic and asymptomatic individuals ( > .17). All precursors demonstrated a secular decrease in prevalence over time. Gastric precursor lesions have differences in prevalence in regions with differential GC incidence and are associated with infection. Because of the substantial prevalence of precursor lesions in both symptomatic and asymptomatic individuals, symptomatic evaluation may not be sufficient to identify individuals at risk. These estimates provide important insights for tailoring GC prevention strategies.

中文翻译：

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胃癌负担不同的国家中胃前体病变的患病率：系统评价和荟萃分析

胃癌 (GC) 前驱病变的患病率以及不同 GC 风险国家之间的负担差异尚不清楚。我们进行了系统回顾和荟萃分析，以估计前驱病变的全球患病率。我们估计了低、中、高GC发病率地区萎缩性胃炎（AG）、胃肠化生（IM）和不典型增生的患病率。由于 IM 是 AG 的晚期表现，因此无论是否存在更晚期的病变，我们都评估了较晚期前兆的患病率。患病率按感染、症状和时期（<2000 年、2000-2010 年和>2010 年）进行了细分。在经过全文审查的 582 篇文章中，166 篇研究符合纳入标准。根据 126 项研究报告，无论是否存在较晚期病变，AG、IM 和不典型增生的全球患病率估计分别为 25.4%、16.2% 和 2.0%，这些研究报告了较晚期前兆的患病率。与 GC 发病率低的国家相比，高和中的所有前驱病变的患病率较高 (< .01)。 AG 和 IM 的患病率在感染个体中显着较高 ( < .01)，但有症状和无症状个体之间没有统计学差异 ( > .17)。所有前体的患病率都随着时间的推移而长期下降。在GC发病率不同的地区，胃前驱病变的患病率存在​​差异，并且与感染相关。由于有症状和无症状个体中前驱病变的患病率很高，因此症状评估可能不足以识别处于危险中的个体。这些估计为制定 GC 预防策略提供了重要的见解。