Mamun Tajul Islam, Younus Sabrina, Rahman Md Hashibur
Department of Epidemiology and Public Health, Sylhet Agricultural University, Sylhet 3100, Bangladesh.
Department of Pharmacy, University of Chittagong, Chattogram 4331, Bangladesh.
Cancer Treat Res Commun. 2024;41:100845. doi: 10.1016/j.ctarc.2024.100845. Epub 2024 Sep 24.
Gastric cancer represents a significant global health challenge due to its high mortality and incidence rates, particularly in Eastern Asia, Eastern Europe, and South America. This comprehensive review synthesizes the latest epidemiological data and explores both modifiable and non-modifiable risk factors associated with gastric cancer, aiming to delineate the multifactorial etiology of this disease. Modifiable risk factors include Helicobacter pylori infection, obesity, dietary habits, smoking and alcohol consumption, whereas nonmodifiable factors comprise genetic predispositions, age, family history and male gender. The interplay of these factors significantly impacts the risk and progression of gastric cancer, suggesting potential preventive strategies. The challenges in treating gastric cancer are considerable, largely because of the late-stage diagnosis and the heterogeneity of the disease, which complicate effective treatment regimens. Current treatment strategies involve a combination of surgery, chemotherapy, radiotherapy, and targeted therapies. The FLOT regimen (5-FU, Leucovorin, Oxaliplatin and Docetaxel) is now a standard for resectable cases in Europe and the US, showing superior survival and response rates over ECF and ECX regimens. For HER2-positive gastric cancer, trastuzumab combined with chemotherapy improves overall survival, as demonstrated by the ToGA trial. Additionally, immune checkpoint inhibitors like pembrolizumab and nivolumab offer promising results. However, the five-year survival rate remains low, underscoring the urgency for improved therapeutic approaches. Recent advancements in molecular biology and cancer genomics have begun to pave the way for personalized medicine in gastric cancer care, focusing on molecular targeted therapies and immunotherapy. This review also highlights the critical need for better screening methods that could facilitate early detection and treatment, potentially improving the prognosis. By integrating epidemiological insights with new therapeutic strategies, this article aims to thoroughly understand of gastric cancer's dynamics and outline a framework for future research and clinical management, advocating for a multidisciplinary approach to tackle this formidable disease.
由于胃癌的高死亡率和发病率，尤其是在东亚、东欧和南美洲，它是一项重大的全球健康挑战。本综述综合了最新的流行病学数据，并探讨了与胃癌相关的可改变和不可改变的风险因素，旨在阐明该疾病的多因素病因。可改变的风险因素包括幽门螺杆菌感染、肥胖、饮食习惯、吸烟和饮酒，而不可改变的因素包括遗传易感性、年龄、家族史和男性性别。这些因素的相互作用显著影响胃癌的风险和进展，提示了潜在的预防策略。治疗胃癌面临的挑战相当大，主要是因为晚期诊断和疾病的异质性使有效的治疗方案变得复杂。目前的治疗策略包括手术、化疗、放疗和靶向治疗的联合应用。FLOT方案（氟尿嘧啶、亚叶酸钙、奥沙利铂和多西他赛）现在是欧美可切除病例的标准方案，与ECF和ECX方案相比，显示出更高的生存率和缓解率。对于HER2阳性的胃癌，曲妥珠单抗联合化疗可提高总生存率，ToGA试验已证明这一点。此外，派姆单抗和纳武单抗等免疫检查点抑制剂也取得了有前景的结果。然而，五年生存率仍然很低，这凸显了改进治疗方法的紧迫性。分子生物学和癌症基因组学的最新进展已开始为胃癌个性化医疗铺平道路，重点是分子靶向治疗和免疫治疗。本综述还强调了迫切需要更好的筛查方法，以便能够促进早期发现和治疗，从而有可能改善预后。通过将流行病学见解与新的治疗策略相结合，本文旨在全面了解胃癌的动态，并概述未来研究和临床管理的框架，倡导采用多学科方法来应对这一棘手的疾病。
