胃癌肝转移分子机制与治疗的研究进展

Research progress on molecular mechanism and treatment of liver metastasis in gastric cancer

目的总结目前胃癌肝转移的分子机制和相关临床治疗的研究进展,为今后的治疗提供思路。检索近年来国内外有关胃癌肝转移分子机制和治疗策略研究的文献并进行综述。结果大多数胃癌患者初诊时已属晚期或已发生远处转移,其中肝脏是胃癌转移的常见部位。胃癌肝转移的机制尚未完全明确,包括非编码RNA、循环肿瘤细胞、外泌体、肿瘤微环境、信号通路等在内的不同水平的分子机制相对独立又相互影响,为胃癌肝转移提供了潜在的生物标志物和治疗靶点。目前胃癌肝转移患者的治疗主要分为局部治疗和全身治疗,局部治疗以手术治疗、射频消融和质子束治疗为主,全身治疗包括全身化疗、靶向治疗和免疫治疗,其中靶向治疗和免疫治疗是最近的研究重点。结论胃癌肝转移是肿瘤细胞与转移部位微环境共同作用的结果,了解这些机制对指导临床治疗和预后具有重大意义。目前胃癌肝转移没有统一的治疗标准,想要达到理想的治疗效果不能只依靠单一治疗,还应根据患者的具体疾病状况和肿瘤的性质,采用多学科和个体化治疗方案。

Objective To summarize the molecular mechanisms and clinical treatment of gastric cancer with liver metastasis(GCLM),in order to provide new ideas for future treatment.Method The literatures about mechanism and treatment strategy of GCLM in recent years were searched and reviewed.Results Most patients with gastric cancer were in advanced stage or had developed distant metastases when they were first diagnosed,among which liver was the common site of metastasis.The complex molecular mechanisms of GCLM had not been fully clarified.Molecular mechanisms at different levels,including non-coding RNA,circulating tumor cells,exosomes,tumor microenvironment and signaling pathways,were relatively independent and interacted with each other,providing potential biomarkers and therapeutic targets for GCLM.At present,the best treatment method for patients with GCLM was mainly divided into local and systemic treatment.The local treatment included surgical treatment,radiofrequency ablation and proton beam therapy,while the systemic treatment included systemic chemotherapy,targeted therapy and immunotherapy,among which the targeted therapy and immunotherapy were the focus of recent research.Conclusions The mechanism of GCLM is the result of the interaction between tumor cells and the microenvironment at the site of metastasis.Understanding them is of great significance to guide clinical treatment and prognosis.At present,there is no unified treatment standard for GCLM.To achieve the ideal treatment effect,we should not only rely on single therapy,but also adopt multi-disciplinary and individual therapy according to the specific disease status of patients and the nature of tumors.