早期胃癌规范化诊治流程及预后因素

Early gastric cancer,the procedure of the diagnosis,treatment and the prognosis

胃癌依然是世界范围内最常见的癌症之一。近些年,在日本,早期胃癌(early gastric cancer,EGC)约占胃癌治疗患者的57%,而在中国,该比例却不足10%。包括内镜粘膜下剥离术(endoscopic submucosal dissection,ESD)和内镜下粘膜切除术(endoscopic mucosal resection,EMR)在内的微创手术,对于EGC患者而言是治愈性的治疗,而且患者会获得很好的预后。对于EGC而言,规范化诊治流程非常重要。首先,内镜、超声内镜及组织学检查是筛选微创手术患者的关键步骤。第二,仔细评估微创手术标本可以为将来可能的外科干预提供重要信息,这些信息包括脉管瘤栓、肿瘤体积、组织学类型、浸润深度。此外,淋巴细胞浸润情况,淋巴管侵犯、HER2/neu,Mucin-4、VEGF C、VEGF D过表达是EGC的预后因素。

Gastric cancer remains one of the most common cancers worldwide. In Japan, about S7% of gastric cancers that currently treated are early gastric cancer （EGC）, but in China, the percentage of EGC that are treated is only 10%. Minimally invasive approaches including endoscopic mucosal resection （EMR） or endoscopic submucosal dissection （ESD） are utilized for curative treatment of EGC and the patients obtained favorable prognosis. It is very important to follow the procedure of the EGC treatment. Firstly, examination of endoscopy, endoscopic ultrasonography and histology are crucial steps of selecting suitable patients for EMR/ESD. Secondly, carefully assessment of EMR/ESD specimens is a very important component to provide information for further surgical intervention, these information including lymph vascular tumor thrombus, tumor size, histological type, and the depth of invasion, Furthermore, lymphoid infiltration, presence of lymphatic invasion, and over-expression of HER2/neu, Mucin-4, VEGF C, VEGF D are associate with prognosis of EGC.