The Role of Endocan Expression in the Diagnosis and Grading of Precancerous Gastric Lesions

<b>Background/Aims:</b> Gastric dysplasia is a critical precursor to gastric cancer (GC), and accurate diagnosis and grading of these lesions are essential for effective surveillance and intervention. However, current diagnostic methods such as forceps biopsy have notable limitations, underscoring the need for reliable biomarkers. This study aimed to evaluate the diagnostic and grading utility of endocan, a soluble proteoglycan secreted by activated endothelial cells, in gastric dysplastic lesions. <b>Methods:</b> A total of 72 patients with gastric dysplasia, 80 with gastric adenocarcinoma, and 55 healthy controls were prospectively enrolled. Endocan expression in gastric tissue samples was assessed via immunohistochemistry and semi-quantitatively graded. Statistical comparisons were made between control, dysplastic (low-grade and high-grade), and malignant groups. <b>Results:</b> Endocan was negatively expressed in all control subjects and positively expressed in 65.3% of the dysplasia group and 100% of the gastric cancer group (<i>p</i> < 0.001). Notably, all high-grade dysplasia cases were endocan-positive, whereas 75.8% of low-grade dysplasia cases were endocan-negative (<i>p</i> < 0.001). <b>Conclusions:</b> This is the first study to demonstrate that endocan is overexpressed in gastric dysplastic lesions. Tissue endocan expression may serve as a practical and robust marker for the diagnosis and grading of gastric dysplasia, potentially enhancing early detection and risk stratification in gastric carcinogenesis.