胃癌研究及诊治新进展

Progress in the clinical research of gastric cancer

胃癌病因的基础研究中发现基因调控异常及多态性,在胃癌发病中起到重要作用。人类表皮生长因子受体2(HER2)和血管内皮生长因子(VEGF)基因的突变和过表达,以及其下游信号转导通路的异常激动与胃癌的发生、转移显著相关,已经成为胃癌分子靶向治疗的靶点。幽门螺杆菌(H.pylori)与胃癌的关系已成定论,H.pylori相关的致病因子包括CagA、VacA和外膜蛋白(OMP)。有证据表明肿瘤本质是一种干细胞疾病,胃癌干细胞研究已经成为胃癌研究新热点。胃癌筛查是胃癌早期诊断的有效方法,目前学者推荐血清PG与H.pylori抗体联合检测作为胃癌筛查的初筛方法(ABC法),已使早期胃癌诊断率高达78%。内镜及病理活检技术取得了很大的进展,多种新型内镜技术已在临床应用,内镜下黏膜下剥离术(ESD)作为早期胃癌治疗的主要手段,已经受到广泛认可,内镜下病变整体切除率达到95%以上。胃癌分子靶向治疗的研究进展很快,很多相关药物已进入临床试验阶段,有望取得重大突破。

Dysregulation and polymorphism of the related genes play important roles in etiopathogenesis of gastric cancer.Genetic mutations and over-expression of human epidermal growth factor receptor 2（HER2） and vascular endothelial growth factor（VEGF） and abnormal activation of downstream signal transduction pathway have significant correlations with the genesis and metastasis of gastric cancer,which have been used as target spots of molecular target therapy to treat gastric cancer.There is no doubt that gastric cancer is closely related to Helicobacter pylori（H.pylori）.Relevant virulence factors of H.pylori include cytotoxin-associated gene A（CagA）,vacuolating cytotoxin A（VacA） and outer membrane protein（OMP）.With the evidence that tumor is essentially a kind of diseases from stem cells,research of stem cells in gastric cancer has became a hot point.Gastric cancer screening is a very effective method for early detection.Recently,some scholars recommended gastric cancer screening using the ABC method（combined measurement of serum pepsinogen and H.pylori antibody） and endoscopy,which made the diagnostic rate of early gastric cancer increased to 78%.Great progress has been achieved in the techniques of digestive endoscopy and pathology biopsy.A diversity of new endoscopic techniques and methods have been widely used clinically.Endoscopic submucosal dissection（ESD） has been widespread accepted as the main approach to treat early gastric cancer with a high resection rate in en bloc greater than 95%.The research of molecular target therapy in gastric cancer has developed rapidly and many related medicines approved to enter clinical trials are promising.