Purpose <p>Fear of progression (FOP) leads to poor clinical outcomes in patients with gastric cancer. This study aimed to clarify the profiles and factors that influence FOP among patients after endoscopic submucosal dissection (ESD) for early gastric cancer.</p> Methods <p>A cross-sectional study was conducted with 262 patients who underwent ESD for early gastric cancer. The convenience sampling method was used to select patients in the gastroenterology outpatient departments of two Grade III and Class A hospitals in Zhejiang Province as survey subjects. A general information questionnaire and the Fear of Progression Questionnaire-Short Form, Perceived Social Support Scale, Herth Hope Index, Brief Illness Perception Questionnaire, and Medical Coping Modes Questionnaire were used to collect the data. Latent profile analysis was used to explore the latent profiles of FOP in patients after ESD for early gastric cancer.</p> Results <p>A total of 262 patients were included in the study. Male patients accounted for 59.2% of the cohort, while those aged 50–59 years constituted 52.7%. Pathological type showed that 65.3% of patients had well-differentiated adenocarcinoma. Latent profile analysis identified two subgroups of FOP: low FOP (55.3%) and high FOP (44.7%). Patients who were female, younger, had no religious belief, and had a lower Herth Hope Index and a higher&#xa0;avoidance dimension score and a higher submission dimension score were prone to severe FOP.</p> Conclusion <p>Research indicates that female patients, younger patients, those without religious beliefs, individuals with lower hope scores, and patients employing avoidance or compliance coping strategies are more prone to severe FOP. Physicians and nurses should pay close attention to these characteristics and provide early intervention.</p>