Epigenetic dynamics in gastric cancer precancerous lesions: From molecular mechanisms to precision risk stratification

Abstract Gastric cancer continues to be a major threat to global health, accounting for a significant number of cancer deaths annually, with precancerous lesions representing critical intervention windows to halt malignant progression. Current risk stratification for malignant transformation in gastric precancerous lesions relies heavily on invasive endoscopic and histopathological assessments, which lack precision in quantifying individual transformation risk. Recent research points to the significance of epigenetic dysregulation in driving the evolution of gastric precancerous lesions: DNA methylation, 5‐hydroxymethylcytosine, non‐coding RNAs, RNA editing and modifications. Integrating multi‐omics epigenetic signatures offers a transformative approach to refining risk stratification, guiding personalised surveillance intervals and therapeutic interventions. Future efforts should prioritise large‐scale clinical validation of epigenetic biomarkers, standardisation of detection technologies, and development of cost‐effective, non‐invasive platforms to bridge mechanistic insights into precision prevention strategies for gastric carcinogenesis.