Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, USA.
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Nat Rev Dis Primers. 2017 Jun 1;3:17036. doi: 10.1038/nrdp.2017.36.
Gastric cancers, with gastric adenocarcinoma (GAC) as the most common histological type, impose a considerable global health burden. Although the screening strategies for early detection have been shown to be successful in Japan and South Korea, they are either not implemented or not feasible in most of the world, leading to late diagnosis in most patients. Helicobacter pylori infection contributes to the development of many endemic GACs, and pre-emptive eradication or early treatment of this bacterial infection might provide effective primary prevention. GACs are phenotypically and genotypically heterogeneous. Localized (clinical stage I) GAC is best treated either endoscopically or with limited surgical resection, but clinical stage II or stage III tumours require multidisciplinary adjunctive approaches in addition to surgery. Although GAC is highly treatable in its early stages, advanced (clinical stage IV) GAC has a median survival of just ∼9-10 months. However, detailed molecular and immune profiling of GAC is yielding promise; early studies with immune checkpoint inhibitors suggest that GAC is amenable to immune modulation. Molecular studies have yielded a vast quantity of new information for potential exploitation. Nevertheless, advances against GACs have lagged compared with other tumours of similar incidence, and more research is necessary to overcome the obstacles to prolong survival.
胃癌，以胃腺癌（GAC）为最常见的组织学类型，对全球健康造成了相当大的负担。虽然在日本和韩国，早期检测的筛查策略已被证明是成功的，但在世界上大多数地方，这些策略要么没有实施，要么不可行，导致大多数患者诊断较晚。幽门螺杆菌感染有助于许多地方性 GAC 的发展，抢先消灭或早期治疗这种细菌感染可能提供有效的初级预防。GAC 在表型和基因型上具有异质性。局部（临床 I 期）GAC 最好通过内镜或有限的手术切除进行治疗，但临床 II 期或 III 期肿瘤除手术外还需要多学科辅助治疗。虽然 GAC 在早期阶段高度可治疗，但晚期（临床 IV 期）GAC 的中位生存期仅约 9-10 个月。然而，对 GAC 的详细分子和免疫分析显示出希望；免疫检查点抑制剂的早期研究表明，GAC 易于免疫调节。分子研究产生了大量新的潜在开发信息。然而，与其他发病率相似的肿瘤相比，GAC 的进展滞后，需要更多的研究来克服延长生存的障碍。
