Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
Expert Rev Gastroenterol Hepatol. 2012 Jun;6(3):335-41. doi: 10.1586/egh.12.7.
Two major gastric cancer histological subtypes are recognized with distinct morphology, epidemiology, pathogenesis and clinical behavior. Genetically, the intestinal and diffuse subtypes are also characterized by distinct germline susceptibility patterns and somatic aberrations. Helicobacter pylori is strongly associated with both Lauren's subtypes, although the underlying carcinogenic mechanisms are unique. Risk is modulated by strain-specific virulence factors, host responses and specific host-microbe interactions. Somatic aberrations in gastric cancer are driven by three major mechanisms, namely chromosomal instability, microsatellite instability and epigenetic alterations. These processes drive carcinogenesis in both Lauren's subtypes; however, the relative contribution of these processes and the specific genes aberrated differ. Moving beyond Lauren's subtypes, next-generation techniques have identified major genomic subtypes that have prognostic impact and exhibit distinct response patterns to standard cytotoxics.
两种主要的胃癌组织学亚型具有不同的形态、流行病学、发病机制和临床行为。从遗传学上讲，肠型和弥漫型也具有不同的种系易感性模式和体细胞异常。幽门螺杆菌与劳伦的两种亚型都有很强的关联，尽管其潜在的致癌机制是独特的。风险由菌株特异性毒力因子、宿主反应和特定的宿主-微生物相互作用调节。胃癌的体细胞异常是由三种主要机制驱动的，即染色体不稳定性、微卫星不稳定性和表观遗传改变。这些过程驱动着劳伦两种亚型的癌变；然而，这些过程的相对贡献和异常的特定基因不同。超越劳伦的亚型，下一代技术已经确定了具有预后影响的主要基因组亚型，并对标准细胞毒素表现出不同的反应模式。
