Mucin phenotype-based deep learning framework for intestinal metaplasia-carcinogenesis progression prediction.

This study decodes spatiotemporal mucin dynamics in gastric carcinogenesis, revealing gastric-type markers (MUC5AC/MUC6) decline progressively while intestinal-type markers (MUC2/CD10) peak in gastric intestinal metaplasia (GIM) before decreasing in gastric cancer (GC). We developed MPMR, a dual-function UNI-pretrained Vision Transformer (ViT) model, which directly predicts four mucin markers from H&E whole-slide images with near-perfect accuracy (AUC: 0.921-0.997) and generates interpretable simulated staining heatmaps via adversarial learning. Integrating these outputs with clinical variables, the MPMR-IMCP risk model significantly outperformed clinical-only models (ΔAUC = 0.050), enabling both phenotype analysis and GIM risk stratification without specialized staining. Validated in longitudinal cohorts from Chinese GC high-incidence regions, this framework offers an efficient solution for monitoring GIM malignant transformation.