Cuschieri A
Department of Surgery, Ninewells Hospital & Medical School, University, Dundee.
Recenti Prog Med. 1990 Jun;81(6):374-86.
The commonest malignant tumour of the stomach is gastric carcinoma. Although the incidence of this neoplasm has declined worldwide, it still ranks fifth to seventh as a cause of cancer-related deaths in the West where the overall 5-year survival from the disease remains poor and averages 5-10%. The decline in the incidence of gastric cancer during the past 4 decades is largely confined to antral tumours of the intestinal type. During this period an absolute increase in the prevalence of cancers of the upper third of the stomach has been observed. Japan is the only country where the mortality has declined proportionately more than the decreased incidence of the disease. This is attributed to a successful screening programme for the detection of early gastric cancer, better staging and probably more aggressive surgical treatment with an extended lymphadenectomy. The latter remains unproven and is currently being evaluated prospectively in a Medical Research Council trial being conducted in the United Kingdom. Surgical excision remains the mainstay of therapy. To date there has been no firm evidence that peri-operative radiotherapy imparts any therapeutic advantage. Overall survival is not improved by adjuvant combination chemotherapy although the early results of a modified FAM regimen with cisplatin are encouraging in terms of response rates. Gastric carcinoids most frequently arise in patients with pernicious anaemia due to the prolonged hypergastrinaemia. Although they can metastasize, their prognosis is good and resection is indicated even in the presence of deposits. Gastric lymphoma accounts for 0.5-3% of gastric malignancies and is the prototype of malignant lymphomas arising from mucosa associated lymphoid tissue (MALT) present in the gastrointestinal tract and other organs. The majority of these tumours are B-cell lymphomas which are slow growing and tend to remain localized until late in the course of the disease. The various accepted histological classifications are difficult to apply to MALT lymphomas which are nowadays regarded as a distinct entity the prognosis of which is determined more by stage than histological type. They frequently cause diagnostic problems because of their indolent growth characteristics and their close simulation to benign lymphoid infiltrates. In the past, the term "pseudolymphoma" was applied to those extranodal proliferations of lymphoid tissue the nature of which was uncertain. This problem has been resolved by the advent of immunocytochemical and molecular biological techniques such that it is now always possible to distinguish a reactive from a neoplastic lymphoid infiltrate.(ABSTRACT TRUNCATED AT 400 WORDS)
胃癌是最常见的胃部恶性肿瘤。尽管全球范围内这种肿瘤的发病率有所下降，但在西方，它仍是癌症相关死亡的第五至第七大原因，该疾病的总体5年生存率仍然很低，平均为5%-10%。过去40年中胃癌发病率的下降主要局限于肠型胃窦肿瘤。在此期间，观察到胃上三分之一癌症的患病率绝对增加。日本是唯一一个死亡率下降幅度超过发病率下降幅度的国家。这归因于一项成功的早期胃癌检测筛查计划、更好的分期，可能还有更积极的手术治疗以及扩大的淋巴结清扫术。后者尚未得到证实，目前正在英国医学研究委员会进行的一项前瞻性试验中进行评估。手术切除仍然是主要的治疗方法。迄今为止，没有确凿证据表明围手术期放疗具有任何治疗优势。辅助联合化疗并未提高总体生存率，尽管含顺铂的改良FAM方案的早期结果在缓解率方面令人鼓舞。胃类癌最常发生于恶性贫血患者，由于长期高胃泌素血症。尽管它们可以转移，但其预后良好，即使存在转移灶也建议进行切除。胃淋巴瘤占胃部恶性肿瘤的0.5%-3%，是起源于胃肠道和其他器官中黏膜相关淋巴组织（MALT）的恶性淋巴瘤的原型。这些肿瘤大多数是B细胞淋巴瘤，生长缓慢，在疾病晚期之前往往局限于局部。各种公认的组织学分类难以应用于MALT淋巴瘤，如今MALT淋巴瘤被视为一个独特的实体，其预后更多地由分期而非组织学类型决定。由于其生长缓慢的特点以及与良性淋巴浸润的相似性，它们经常导致诊断问题。过去，“假性淋巴瘤”一词用于那些性质不确定的淋巴结外淋巴组织增生。免疫细胞化学和分子生物学技术的出现解决了这个问题，现在总是能够区分反应性淋巴浸润和肿瘤性淋巴浸润。（摘要截取自400字）
