Axon Anthony
Department of Gastroenterology, The General Infirmary at Leeds, Leeds, UK.
Best Pract Res Clin Gastroenterol. 2006;20(4):697-708. doi: 10.1016/j.bpg.2006.03.015.
Five-year survival of gastric cancer is 10% in Western countries compared with over 50% in Japan. This is because the disease is not identified in the West until later in its evolution. T1 cancer has an excellent prognosis, but most of the patients either have no symptoms or complain of long-standing, non-specific dyspepsia; alarm symptoms, when identified, usually indicate that the cancer is already inoperable. Early gastric cancer is infrequently diagnosed in the West because the low prevalence of gastric cancer means that endoscopists do not search with the same diligence as they do in Japan. A further barrier is the widespread prescription of proton pump inhibitors that heal malignant ulcers and diminish symptoms, thus rendering them more difficult to identify clinically and endoscopically. An improvement in diagnosis may be achieved by newer endoscopy technology which enables cancers to be identified more easily, or by an inexpensive screening test to select patients with extensive gastric atrophy, thereby identifying those at risk who can then be screened endoscopically.
在西方国家，胃癌患者的五年生存率为10%，而在日本这一比例超过50%。这是因为在西方，这种疾病直到病情发展到后期才被发现。T1期癌症预后良好，但大多数患者要么没有症状，要么主诉长期存在的非特异性消化不良；当出现警示症状时，通常表明癌症已无法手术切除。早期胃癌在西方很少被诊断出来，因为胃癌的低发病率意味着内镜医师不像在日本那样积极地进行筛查。另一个障碍是质子泵抑制剂的广泛使用，它能治愈恶性溃疡并减轻症状，从而使这些症状在临床和内镜检查中更难被发现。可以通过更新的内镜技术更容易地识别癌症，或者通过廉价的筛查测试来选择患有广泛性胃萎缩的患者，从而识别出有风险的患者，然后对其进行内镜检查，以此来改善诊断情况。
