胃癌经典分型在分子分型时代的临床诊断价值

Evaluation of traditional pathological classification at molecular classification era for gastric cancer

胃癌病理组织学分型在胃癌的基础研究与临床诊治中均占有举足轻重的地位。然而，胃癌在基础研究与临床实际应用上使用的分型体系存在不同，不同文献中采用的分型也不尽一致，时而用Lauren分型,时而用WHO分型．给胃癌研究带来一定的困惑。Lauren分型方案从提出至今历经半个世纪考验，仍然显示出其简便、易行且具有一定预后指导意义的优势；WHO分型方案优于Lauren分型方案之处是“与时俱进”，其根据胃癌研究进展而不断加以修订．始终是临床病理诊断中使用的常用方案。随着基因组学、转录组学、蛋白质组学和代谢组学等“组学”研究的开展，对海量研究数据的深入挖掘分析．胃癌的分子分型是当前研究热点。以往依据肿瘤表型特征决定治疗方案的做法极有可能被依据基因变异特征的模式所取代。针对同一种分子变异的基因靶向治疗要比针对同一种组织形态的化学治疗更趋合理。

Histopathological classification is in a pivotal position in both basic research and clinical diagnosis and treatment of gastric cancer. Currently, there are differentclassification systems in basic science and clinical application. In medical literatures, different classifications are used including Lauren and WHO systems, which have confused many researchers. Lauren classification has been proposed for half a century, but is still used worldwide. It shows many advantages of simple, easy handling with prognostic significance. The WHO classification scheme is better than Lauren classification in that it is continuously being revised according to the progress of gastric cancer, and is always used in the clinical and pathological diagnosis of common scenarios. Along with the progression of genomics, transcriptomics, proteomics, metabolomics researches, molecular classification of gastric cancer becomes the current hot topics. The traditional therapeutic approach based on phenotypic characteristics of gastric cancer will most likely be replaced with a gene variation mode. The gene-targeted therapy against the same molecular variation seems more reasonable than traditional chemical treatment based on the same morphological change.