Early gastric cancer (EGC) represents the most critical yet biologically least understood stage in gastric carcinogenesis.

Although the pathological progression from chronic gastritis to atrophic gastritis, intestinal metaplasia, and eventually carcinoma has been well established, most existing studies have focused on individual cell types or isolated molecular events.

Such reductionist approaches fail to explain why tumour initiation preferentially occurs within specific spatial contexts and lack a systematic understanding of the coordinated interplay among inflammation, epithelial plasticity, and the immune microenvironment.

By integrating single-cell RNA sequencing with spatial transcriptomics, this study systematically delineates the cellular composition and spatial transcriptional architecture across non-atrophic gastritis, atrophic gastritis, and early gastric cancer.

At the spatial level, we demonstrate for the first time that early gastric cancer arises from an inflammation-driven, highly coordinated spatial microenvironmental state.

We define this state as an inflammation-associated spatial niche, characterised by the selective maintenance of epithelial stem-like programmes, enhanced inflammatory chemotactic signalling, and the regional enrichment of immunosuppressive cell populations.

The study was published online in Chinese Medical Journal.

Mechanistically, we identify the SOX9-CXCL axis as a key downstream regulatory module within the inflammatory spatial niche, linking epithelial stemness maintenance to macrophage recruitment and immune microenvironment remodelling.

Furthermore, we demonstrate that concurrent targeting of CXCR2- and CSF1R-mediated pathways effectively disrupts the structural integrity of the inflammatory niche, thereby significantly suppressing early gastric cancer progression.

Conceptually, this study introduces the spatial niche as a fundamental regulatory unit for understanding early gastric cancer initiation, moving beyond traditional paradigms centred on single-cell or single-gene events.

Methodologically, it highlights the unique value of integrative spatial multi-omics approaches in resolving complex inflammation-to-tumour progression trajectories.

Clinically, our findings provide a novel framework for early gastric cancer risk stratification and intervention, suggesting that targeting inflammation-associated spatial niches, rather than isolated tumour cell populations, may enable earlier and more precise therapeutic strategies.

Collectively, this work establishes an important theoretical foundation and potential translational direction for early gastric cancer prevention and spatial microenvironment-oriented therapies.

Source: Chinese Medical Journals Publishing House Co., Ltd.