炎症水平相关指标与胃癌患者预后的关系

The Relationship between Inflammation Level Related Indicators and Prognosis of Gastric Cancer Patients

胃癌(Gastric cancer)被定义为源自胃的原发性上皮恶性肿瘤,是一种具有多种危险因素的复杂异质性疾病。尽管在过去几十年中,GC在各个国家的发病率和死亡率总体呈下降趋势,但GC仍然是全球第五大最常见的恶性肿瘤和癌症相关死亡的第四大原因。早期胃癌的主要治疗方法是内镜切除术,非早期胃癌通过手术治疗。围手术期或辅助化疗可提高1B期或更高分期癌症患者的生存率,晚期胃癌采用序贯化疗,从一线铂类和氟嘧啶双联疗法开始。获准用于治疗胃癌的靶向疗法包括曲妥珠单抗(HER2阳性患者一线治疗)、雷莫芦单抗(抗血管生成二线治疗)和纳武利尤单抗或帕博利珠单抗(抗PD-1三线治疗)。在过去的40年中,基于氟尿嘧啶的方案仍然是辅助化疗的一线选择。然而,几项经典临床试验表明,辅助化疗组患者的总生存期仅略高于单手术组,这表明并非所有患者都能从辅助化疗中获益。这些发现强烈强调了对GC进行进一步分类、识别具有不同复发风险的患者以及确定化疗获益可能性的迫切需要。因此,如何延长胃癌患者的生存时间、提高患者的生存率是目前临床研究的重点。营养状况较差常存在于恶性肿瘤患者中,不良的营养状况可能会增加患者围术期并发症的发生率及死亡率,导致较差的预后;炎症与肿瘤常常相互作用,肿瘤诱发机体炎症加剧、炎症进一步促进肿瘤进程。目前临床上已有多种反应机体营养状况及炎症水平的指标,本文就患者的营养状况、炎症水平相关指标与胃癌患者预后的关系进行综述,为临床医生提供预测患者预后的信息,为患者制定个性化且具体的诊疗方案。

Gastric cancer, defined as a primary epithelial malignant tumor derived from the stomach, is a complex and heterogeneous disease with multiple risk factors. Despite the overall decreasing trend of GC incidence and mortality in various countries over the past decades, GC remains the fifth most common cause of malignancy and fourth cancer-related death worldwide. The main treatment for early gastric cancer is endoscopic resection. Non-early surgical gastric cancer is treated by surgery. Perioperative or adjuvant chemotherapy improves survival in patients with stage 1B or higher cancer. Advanced gastric cancer uses sequential chemotherapy, starting with first-line platinum and fluoropyrimidine bitherapy. Targeted therapies approved for the treatment of gastric cancer include trastuzumab (first-line therapy in HER2-positive patients), ramolumab (second-line therapy), and navulizumab or pabolizumab (anti-PD-1 third-line therapy). In the past 40 years, fluorouracil-based regimens remain the first-line option for adjuvant chemotherapy. However, several classic clinical trials showed that overall survival in patients in the adjuvant chemotherapy group was only slightly higher than in the single-surgery group, suggesting that not all patients benefit from adjuvant chemotherapy. These findings strongly highlight the urgent need for further classification of GC, identification of patients with different risks of recurrence, and determining the possibility of benefit from chemotherapy. Therefore, how to prolong the survival time and improve the survival rate of GC patients is the focus of clinical research. Poor nutritional status often exists in patients with malignant tumors. Poor nutritional status may increase the incidence and mortality of perioperative complications and mortality of patients, leading to poor prognosis;inflammation and tumor often interact to induce inflammation and further promote the tumor process. At present, there are various indicators reflecting the nutritional status and inflammation level of the body in clinical practice. This paper reviews the relationship between the nutritional status and inflammation level and the prognosis of gastric cancer patients, so as to provide clinicians with information to predict the prognosis of patients, and to formulate personalized and specific diagnosis and treatment plans for patients.