Correa P, Chen V W
Department of Pathology, Louisiana State University Medical Center, New Orleans 70112.
Cancer Surv. 1994;19-20:55-76.
Most countries with adequate statistical infrastructure have registered declines in gastric cancer mortality and incidence rates. Such a trend is dominated by the most frequent variant, namely the so-called intestinal type of adenocarcinoma, usually ulcerated and occupying predominantly the antrum and the antrum-corpus junction. This variant is considered the endstage of a prolonged precancerous process with gradual progression from (a) chronic active gastritis to (b) multifocal atrophic gastritis to (c) intestinal metaplasia, first resembling the phenotype of the small intestine and later that of the colon, to (d) dysplasia and (e) finally to invasive carcinoma. Major trends in dietary habits, namely lower intake of salt and increased and more frequent consumption of fresh fruits and vegetables, have been linked to the decline. In parallel with those trends, improved sanitation and more adequate housing may be responsible for the declining rates of infection with Helicobacter pylori, the major cause of chronic active gastritis. A decline in the frequency of papillary adenocarcinoma of the oxyntic mucosa, associated with the pernicious anaemia syndrome, appears to have taken place much earlier. Although the frequency of the pernicious anaemia syndrome seems to have remained at similar levels, its complications in terms of papillary adenocarcinoma have decreased in populations of northern European extraction. This may be related to time trends in dietary habits. The secular decline in diffuse carcinoma has been either of much less magnitude or non-existent. Few clues are available on this tumour variant. It is somewhat predominant in women, in subjects of blood group A phenotype, and less frequent in older subjects. Cell lines derived from diffuse carcinomas lack functional calcium dependent adhesion molecules ("cadherins"). Recent increases in incidence rates have been registered for adenocarcinoma of the gastric cardia. This increase parallels that of lower oesophageal adenocarcinoma, frequently linked with Barrett's oesophagus, reflux oesophagitis, a history of duodenal ulcer and gastric hypersecretion. New developments in molecular biology are being used to study the process of gastric carcinogenesis. There is hope that specific molecular alterations may provide better understanding of the different variants of gastric carcinoma and their secular trends.
大多数具备完善统计体系的国家，胃癌死亡率和发病率均呈下降趋势。这一趋势主要体现在最常见的类型上，即所谓的肠型腺癌，通常为溃疡型，主要累及胃窦及胃窦 - 胃体交界处。这种类型被认为是一个长期癌前过程的终末期，该过程从（a）慢性活动性胃炎逐渐发展至（b）多灶性萎缩性胃炎，再到（c）肠化生，起初类似小肠的表型，随后类似结肠的表型，接着发展为（d）发育异常，最终（e）演变为浸润性癌。饮食习惯的主要变化趋势，即盐摄入量降低以及新鲜水果和蔬菜的消费增加且更为频繁，与这种下降趋势相关。与这些趋势同时出现的是，卫生条件的改善和住房条件的更趋完善可能是幽门螺杆菌感染率下降的原因，幽门螺杆菌是慢性活动性胃炎的主要病因。胃体黏膜乳头状腺癌的发病率下降似乎早得多，该癌症与恶性贫血综合征相关。尽管恶性贫血综合征的发病率似乎保持在相似水平，但在北欧血统人群中，其在乳头状腺癌方面的并发症有所减少。这可能与饮食习惯的长期变化趋势有关。弥漫性癌的长期下降幅度较小或根本不存在。关于这种肿瘤类型的线索很少。它在女性、血型为 A 型的人群中较为常见，而在老年人群中较少见。源自弥漫性癌的细胞系缺乏功能性钙依赖性黏附分子（“钙黏蛋白”）。胃贲门腺癌的发病率近期有所上升。这种上升与下食管腺癌的上升趋势平行，下食管腺癌常与巴雷特食管、反流性食管炎、十二指肠溃疡病史以及胃酸分泌过多有关。分子生物学的新进展正被用于研究胃癌的发生过程。人们希望特定的分子改变能够为更好地理解胃癌的不同类型及其长期趋势提供帮助。
