Allgayer H, Heiss M M, Schildberg F W
Department of Surgery, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Germany.
Br J Surg. 1997 Dec;84(12):1651-64.
Despite gastric cancer being common, its prognosis has not been improved significantly in recent years. Now, greater insight has been gained into the biological properties of tumour cells, how they become malignant and what mechanisms they may use to invade and metastasize. This involves tumour-associated protease systems, loss or mutation of adhesion molecules and changes in genetics. The view of gastric cancer is changing: it is not only a solid tumour but also exhibits a minimal residual disease component even in the early stages of disease. Such biological tumour characteristics may provide new prognostic factors and also potential new therapeutic options.
This is an update of prognostic factors in gastric cancer, emphasizing new biological features, some of which have been investigated by this group over the past few years. Current results are discussed in the light of 212 references obtained from the Medline database from 1979 to 1997.
There is high probability that some of the factors reviewed, such as c-erbB-2, individual course and phenotyping of disseminated tumour cells will become significant new prognostic variables. This is true also, to a lesser extent, of cathepsin D, matrix metalloproteinase 2 combined with activators or tissue inhibitor of metalloproteinases 2, CD44, E-cadherin, p53 and cripto. Plasminogen activator inhibitor 1 (PAI-1), a member of the urokinase-type plasminogen activator (uPA) system, can already be defined as an established new prognostic factor in gastric cancer.
PAI-1 should be considered prognostically in addition to established tumour classifications. Moreover, the uPA system is a target for future therapeutic concepts. Further analysis of factors describing tumour biology should lead to new, functionally orientated, tumour classifications in gastric cancer.
尽管胃癌很常见，但近年来其预后并未得到显著改善。如今，人们对肿瘤细胞的生物学特性、它们如何变得恶性以及可能用于侵袭和转移的机制有了更深入的了解。这涉及肿瘤相关蛋白酶系统、黏附分子的缺失或突变以及基因变化。对胃癌的看法正在改变：它不仅是一种实体瘤，而且即使在疾病早期也表现出微小残留病灶成分。这种生物学肿瘤特征可能提供新的预后因素以及潜在的新治疗选择。
这是一篇关于胃癌预后因素的更新文章，重点强调了新的生物学特征，其中一些特征在过去几年中已由该研究团队进行了研究。根据从1979年至1997年的Medline数据库中获取的212篇参考文献对当前结果进行了讨论。
所综述的一些因素，如c-erbB-2、播散肿瘤细胞的个体病程和表型分析，很有可能成为重要的新预后变量。组织蛋白酶D、基质金属蛋白酶2与激活剂或金属蛋白酶组织抑制剂2结合、CD44、E-钙黏蛋白、p53和cripto在一定程度上也是如此。纤溶酶原激活物抑制剂1（PAI-1）是尿激酶型纤溶酶原激活物（uPA）系统的成员，已可被定义为胃癌中既定的新预后因素。
除了既定的肿瘤分类外，PAI-在预后方面也应予以考虑。此外，uPA系统是未来治疗理念的一个靶点。对描述肿瘤生物学的因素进行进一步分析应能导致胃癌新的、功能导向性的肿瘤分类。
