Fakhri Bita, Lim Kian-Huat
Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO 63110, USA.
J Gastrointest Oncol. 2017 Jun;8(3):379-386. doi: 10.21037/jgo.2016.11.01.
The historical approach of diagnosing cancer types based entirely on anatomic origin and histologic features, and the "one-size-fit-all" therapeutic approach, are inadequate in modern cancer treatment. From decades of research we now know that cancer is a highly heterogeneous disease driven by complex genetic or epigenetic alterations. The advent of various high throughput molecular tools has now enabled us to view and sub-classify each cancer type based on their distinct molecular features, in addition to histologic classification, with the promise of individualized treatment strategies tailored towards each specific subtype to improve patient outcomes. In this review, we have made an effort to systematically review the most up-to-date, leading literature in molecular analysis and/or subtyping of major gastrointestinal cancers. These include esophageal squamous cell carcinoma (ESCC), gastric cancer (GC) adenocarcinoma, pancreatic ductal adenocarcinoma (PDAC), hepatocellular carcinoma (HCC), gallbladder cancer (GBC), and colorectal cancer (CRC). For each cancer type we summarized the global mutational landscape, subgroup classification based on genomics, epigenetics, gene expression and/or proteomic analysis, and their salient clinicopathological features. We have highlighted the actionable mutations or mutational pathways that could help guide targeted therapies in the future.
完全基于解剖学起源和组织学特征来诊断癌症类型的传统方法,以及“一刀切”的治疗方法,在现代癌症治疗中是不够的。经过数十年的研究,我们现在知道癌症是一种高度异质性疾病,由复杂的基因或表观遗传改变驱动。各种高通量分子工具的出现,使我们现在能够除了组织学分类之外,还能根据其独特的分子特征对每种癌症类型进行观察和细分,有望针对每种特定亚型制定个性化治疗策略,以改善患者预后。在本综述中,我们努力系统地回顾了主要胃肠道癌症分子分析和/或亚型分类方面的最新领先文献。这些癌症包括食管鳞状细胞癌(ESCC)、胃癌(GC)腺癌、胰腺导管腺癌(PDAC)、肝细胞癌(HCC)、胆囊癌(GBC)和结直肠癌(CRC)。对于每种癌症类型,我们总结了全球突变图谱、基于基因组学、表观遗传学、基因表达和/或蛋白质组学分析的亚组分类,以及它们显著的临床病理特征。我们强调了那些有助于指导未来靶向治疗的可操作突变或突变途径。