Fiorillo Claudio, Laterza Vito, Quero Giuseppe, Menghi Roberta, Cina Caterina, Rosa Fausto, Tortorelli Antonio Pio, Boskoski Ivo, Alfieri Sergio
Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore di Roma, Italy.
Surg Oncol. 2020 Sep;34:86-95. doi: 10.1016/j.suronc.2020.04.004. Epub 2020 Apr 5.
Gastric cancer is the third most common cause of cancer related death. Although its incidence is globally declined, prognosis remains dismal in the Western hemisphere, while better outcomes are evidenced in Asian countries. Endoscopic or surgical resection with or without lymphadenectomy represents the only chance of cure, with limited improvements of the prognosis in case of associated chemotherapy in a neoadjuvant or adjuvant setting. This could be mainly attributed to the uniform fashion of treatment of gastric cancer, mainly based on the histological features, that usually do not reflect the complexity of the disease. With the recent introduction of genomic technologies and new generation sequencing techniques, gastric cancer biology is now investigated in great details. This has brought to the publication of three main molecular classifications, based on the underlying molecular biology of gastric cancer. Although only few clinical reports are currently present in literature, the identification of gastric cancer molecular subtypes has shown interesting findings that may pave the way to a tailored clinical and surgical management. The aim of this review is, thus, to give a comprehensive overview of the current molecular classifications as compared to the available histopathological ones, also focusing on the potential clinical and surgical benefits and the future perspectives for a more personalized treatment of gastric cancer.
胃癌是癌症相关死亡的第三大常见原因。尽管其发病率在全球范围内呈下降趋势，但在西半球预后仍然不佳，而亚洲国家则有较好的治疗结果。内镜或手术切除（伴或不伴淋巴结清扫）是唯一的治愈机会，在新辅助或辅助治疗中联合化疗时预后改善有限。这主要归因于胃癌治疗方式单一，主要基于组织学特征，通常无法反映疾病的复杂性。随着基因组技术和新一代测序技术的近期引入，目前对胃癌生物学进行了深入研究。这催生了基于胃癌潜在分子生物学的三种主要分子分类方法。尽管目前文献中仅有少数临床报告，但胃癌分子亚型的鉴定已显示出一些有趣的发现，可能为个性化的临床和手术管理铺平道路。因此，本综述的目的是全面概述当前的分子分类，并与现有的组织病理学分类进行比较，同时关注潜在的临床和手术益处以及胃癌更个性化治疗的未来前景。
