The International Agency for Research on Cancer (IARC), based in Lyon, France, has released a landmark systematic review that sheds new light on metabolites linked to precancerous gastric lesions—the early stages of gastric cancer development. Published on February 18, 2026, in the Journal of the National Cancer Institute (JNCI), this comprehensive analysis draws from 52 studies spanning 2004 to 2025, offering European researchers and clinicians valuable insights into potential biomarkers for early intervention.

Gastric cancer remains a significant public health challenge across Europe, where it accounts for approximately 100,000 new cases annually despite declining incidence rates due to improved Helicobacter pylori (H. pylori) eradication programs. Precancerous gastric lesions, such as chronic atrophic gastritis and intestinal metaplasia, represent critical windows for prevention, yet detecting them early remains difficult. This IARC-led effort, in collaboration with Seoul National University, evaluates circulating endogenous metabolites as non-invasive tools for risk stratification.

🔬 Methodology Behind the IARC Review

The review systematically searched databases including PubMed, Embase, and Web of Science for studies assessing metabolites in relation to precancerous gastric lesions, gastric cancer (GC), or GC subtypes. Inclusion criteria focused on human studies measuring endogenous metabolites in blood, urine, gastric juice, or tissue, with case-control, cohort, or nested designs.

A total of 52 studies qualified: 12 case-only, 31 case-control, five nested case-control, and four cohort studies. Data synthesis considered study design, biospecimen type, analytical methods (e.g., NMR, MS-based metabolomics), H. pylori status, and model performance. Led by IARC researchers Mazda Jenab and Viktoria Knaze from the Nutrition and Metabolism Branch in Lyon, alongside Pekka Keski-Rahkonen, the team highlighted substantial heterogeneity but identified consistent patterns.

This rigorous approach underscores IARC's role as Europe's premier cancer research hub, fostering collaborations that advance metabolomics in oncology.

Key Metabolic Pathways Disrupted in Precancerous Stages

The review pinpointed alterations primarily in glucose, lipid, amino acid, nucleic acid, and vitamin metabolism. For precancerous gastric lesions, glucose metabolism showed depletion in several studies, suggesting early hypoglycemic shifts as cells adapt to chronic inflammation often triggered by H. pylori.

Lipid metabolism dysregulation was prominent, with elevated free fatty acids and altered phospholipids indicating membrane remodeling. Amino acid changes included branched-chain amino acids (BCAAs) like leucine and isoleucine, often elevated, reflecting increased protein turnover. Nucleic acid metabolites, such as purines and pyrimidines, pointed to heightened cell proliferation, while vitamin-related compounds like myo-inositol hinted at antioxidant deficiencies.

These findings align with broader gastric carcinogenesis models, where Correa's cascade—from superficial gastritis to invasive GC—involves progressive metabolic reprogramming.

Promising Metabolite Biomarkers for Precancerous Lesions

Specific metabolites repeatedly associated with precancerous lesions include aromatic amino acids (phenylalanine, tyrosine, tryptophan) in gastric juice, potentially serving as non-invasive urine or blood proxies. Glucose depletion and lipid peroxidation products emerged in multiple cohorts, particularly those adjusting for H. pylori.

• Glucose: Consistently lower in atrophic gastritis cases.
• Lipids (e.g., lysophosphatidylcholines): Elevated, linked to inflammation.
• Amino acids (BCAAs, aromatic): Dysregulated, prognostic for progression.
• Vitamin B metabolites: Deficient, tied to one-carbon metabolism.

Several panels combining 3-10 metabolites achieved AUCs of 0.80-0.95 for distinguishing lesions from healthy controls, outperforming single markers.

European Context: Gastric Cancer Burden and Research Landscape

In the European Union, gastric cancer incidence has dropped 30% over two decades, yet it causes over 68,000 deaths yearly (2025 estimates). High-risk regions like Eastern Europe report rates up to 20/100,000, versus under 10 in Western Europe. IARC's Lyon-based team emphasizes Europe's leadership in cohort studies like EPIC, which provide pre-diagnostic samples for validation.

Universities such as those in France (e.g., INSERM affiliates) and Germany (DKFZ Heidelberg) are advancing metabolomics platforms. For instance, the EU-funded GAINS project develops gastric cancer prevention guidelines, integrating metabolite data.IARC GAINS Project

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Challenges: Heterogeneity and Confounders

Despite promising signals, high inter-study variability arose from differences in metabolomics platforms (LC-MS vs. NMR), sample types, and confounders like diet, smoking, and H. pylori status. Only 20% of studies adjusted fully for infection, a Group 1 carcinogen.

Prospective cohorts showed stronger associations than case-controls, but small sample sizes limited power. The review calls for standardized protocols and large-scale validation in diverse European populations.

From Bench to Clinic: Biomarker Potential

Metabolite panels could enable liquid biopsies for screening high-risk Europeans, such as those with family history or H. pylori persistence. Models distinguishing precancerous lesions from GC achieved moderate accuracy, suggesting utility in surveillance post-endoscopy.

In Europe, where endoscopy uptake varies (high in Japan/Korea models), non-invasive tests align with cost-effective strategies. Ongoing IARC projects like Meta-GCProspect test pre-diagnostic signatures.

Implications for Prevention in Europe

Metabolite insights reinforce H. pylori eradication and dietary interventions targeting lipid/glucose dysregulation. The EU's Beating Cancer Plan invests €4B in prevention; metabolite monitoring could prioritize at-risk groups.

Universities like the University of Lyon and Helsinki are pioneering metabolomics cohorts. Researchers can access IARC's EPIC biobank for studies.European higher ed jobs

Future Directions for European Metabolomics Research

Next steps include multi-omics integration (metabolites + genomics) and AI-driven panels. EU Horizon Europe funds (€95B) support gastric cancer consortia. Challenges: harmonizing assays across labs.

Collaboration between IARC and universities like those in Spain (Barcelona) and Italy (Milan) will accelerate translation. Aspiring researchers, check academic CV tips.

Photo by Brett Jordan on Unsplash

Conclusion: A Step Toward Eradicating Gastric Cancer

This IARC review marks a pivotal advance in understanding metabolic drivers of precancerous gastric lesions, paving the way for precision prevention in Europe. By validating these biomarkers, we can shift from reactive treatment to proactive screening, saving lives and resources.

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