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Although clinical, endoscopic, and histological findings underpin current risk stratification, outcome heterogeneity persists among individuals with similar phenotypes. Here, we review evidence supporting the gastric \u201cmultimodal field\u201d as an additional risk assessment layer, emphasizing inflammation\u2010 and exposure\u2010associated DNA methylation as a scalable biomarker of field cancerization. Prospective studies and deep profiling of high\u2010risk intestinal metaplasia support methylation\u2010based field cancerization. In a longitudinal health check\u2010up cohort, our work supports an integrated approach combining methylation markers with routinely available clinical variables. We discuss near\u2010term multimodal extensions that may improve interpretability and predictive precision and support more effective personalized surveillance strategies.\n                  <\/jats:p>","DOI":"10.1111\/cas.70432","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T03:51:17Z","timestamp":1780458677000},"page":"2323-2334","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gastric Mucosal Molecular Alterations and Multimodal Field\u2010Based Risk Models for Gastric Cancer Development"],"prefix":"10.1111","volume":"117","author":[{"given":"Genki","family":"Usui","sequence":"first","affiliation":[{"name":"Department of Molecular Oncology, Graduate School of Medicine Chiba University  Chiba Japan"},{"name":"Department of Quantitative Biomedicine University of Zurich  Zurich Switzerland"},{"name":"Institute for Molecular Health Sciences, ETH Zurich  Zurich 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