Röcken C, Warneke V
Institut für Pathologie, Christian-Albrechts-Universität Kiel, Arnold-Heller-Str. 3/14, 24105 Kiel.
Pathologe. 2012 Nov;33 Suppl 2:235-40. doi: 10.1007/s00292-012-1634-4.
Gastric cancer is one of the most common cancers worldwide. In recent decades, major advancements in the understanding of the epidemiology, pathology and pathogenesis of gastric cancer have been witnessed. Infections with Helicobacter pylori or Epstein-Barr virus, dietary and lifestyle factors contribute to the risk of developing gastric cancer. With respect to pathogenesis at least three distinct types of gastric cancer exist, (1) proximal, (2) distal diffuse and (3) distal non-diffuse types. Genetic and epigenetic alterations are related to oncogene mutations and tumor suppressor gene inactivation. Canonical oncogenic pathways such as the WNT/β-catenin signaling pathway are de-regulated in gastric cancer. Hereditary and familial type gastric cancers are currently linked to CDH1 gene mutations and various genetic polymorphisms determining disease susceptibility. Molecular subtypes of gastric cancer have been identified which separate diffuse from intestinal type gastric cancer and are not entirely congruent with the histopathological phenotype according to Laurén but may influence chemosensitivity. Putative cancer stem cell markers of gastric cancer have been found (e.g. ADAM17, CD133, FZD7, LGR5) and correlate with patient prognosis. Thus, molecular phenotyping of gastric cancer is still in its infancy and the search for novel diagnostic, prognostic and predictive biomarkers continues.
胃癌是全球最常见的癌症之一。近几十年来，人们在胃癌的流行病学、病理学和发病机制的认识上取得了重大进展。幽门螺杆菌或爱泼斯坦-巴尔病毒感染、饮食和生活方式因素会增加患胃癌的风险。就发病机制而言，至少存在三种不同类型的胃癌，（1）近端型，（2）远端弥漫型和（3）远端非弥漫型。基因和表观遗传改变与癌基因突变和肿瘤抑制基因失活有关。经典致癌途径如WNT/β-连环蛋白信号通路在胃癌中失调。遗传性和家族性胃癌目前与CDH1基因突变以及决定疾病易感性的各种基因多态性有关。已经确定了胃癌的分子亚型，这些亚型将弥漫型与肠型胃癌区分开来，并且与劳伦（Laurén）的组织病理学表型并不完全一致，但可能影响化疗敏感性。已经发现了胃癌的假定癌症干细胞标志物（例如ADAM17、CD133、FZD7、LGR5），并且与患者预后相关。因此，胃癌的分子表型分析仍处于起步阶段，对新型诊断、预后和预测生物标志物的探索仍在继续。
