同时性多发性胃癌的诊疗进展

Progress in the diagnosis and treatment of synchronous multiple gastric cancer

同时性多发性胃癌是指胃内不同部位同时出现2个及以上的独立肿瘤,是一种较为少见的胃癌类型,约占胃癌总发病率的6%～14%。目前,多发性胃癌分为单克隆起源及多克隆起源多发性胃癌,部分肿瘤存在遗传易感性和错配修复基因突变。多发性胃癌多见于老年男性,好发于近端胃,早期胃癌多见,与单发性胃癌相比,其脉管癌栓、分化及淋巴结转移情况等临床病理特征方面均无显著性差异。根据分期及发病位置不同,多发性胃癌患者可行内镜下局部切除、部分胃切除和全胃切除等治疗方法。对于存在遗传易感性的多发性胃癌患者,是否需行扩大性胃切除术则需进一步探讨。

Synchronous multiple gastric cancer is a rare condition involving multiple malignant tumors at different sites in the stomach.Such cases account for 6%-14%of all gastric cancers.Currently,cases of multiple gastric cancer can be classified by the monoclonal or polyclonal nature of the original tumor.Some patients with multiple gastric cancer exhibit hereditary susceptibility and mutations in mismatch repair genes.Multiple gastric cancer occurs more commonly among elderly male patients and in the proximal stomach at an early stage.No significant differences in vascular invasion,differentiation status,and lymph node metastasis have been identified between solitary and multiple gastric cancers.Several treatment approaches for multiple gastric cancer have been applied clinically,including endoscopic resection and subtotal and total gastric resection according to the tumor stages and sites.Further discussion is needed regarding the extension of gastric resection for multiple gastric cancer in patients with hereditary susceptibility.