Gastric cancer: epidemiology, prevention, and therapy
Gastric cancer: epidemiology, prevention, and therapy
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DOI：
10.1111/hel.12518
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发表时间：
2018-09-01
期刊：
影响因子：
4.4
通讯作者：
Malfertheiner, Peter
中科院分区：
文献类型：
--
作者：
Venerito, Marino;Vasapolli, Riccardo;Malfertheiner, Peter
胃癌（GC）仍然是世界范围内男性和女性癌症死亡的第三大原因。幽门螺杆菌感染是胃癌最重要的危险因素，尽管发病率呈持续下降趋势，但2015年约有44亿人感染幽门螺杆菌，占世界人口的一半以上。一项系统性综述中报告的幽门螺杆菌感染减少的出生队列模式有助于解释日本GC死亡率下降的原因。GC发病率估计年百分比变化的当前趋势预示了美国非西班牙裔白人发病率下降和男性优势的预期逆转。结合血清胃蛋白酶原1和幽门螺杆菌血清学被证明是有用的GC危险分层在芬兰的人口。在一项大型前瞻性研究中，通过胃炎评估的手术环节进行的胃癌分期被证实在预测胃癌风险方面是可靠的。在韩国的一项随机试验中，幽门螺杆菌根除治疗显著降低了因早期GC接受根治性内镜切除术的患者的异时性GC发生率。根据香港医院管理局的全港医疗数据库进行的一项研究显示，服用阿司匹林与降低胃癌风险有关。基于同一数据库的另一项研究表明，质子泵抑制剂增加GC风险，但方法学偏倚很可能是混杂因素。关于内镜粘膜下剥离术在早期胃癌患者中的作用的实验数据已经发表。III期FLOT 4试验表明，与ECF三联方案（表阿霉素、顺铂和5-氟尿嘧啶）相比，FLOT三联方案（多西他赛、奥沙利铂、甲酰四氢叶酸和5-氟尿嘧啶）改善了GC和局部疾病患者的结局。在III期ATTRACTION-2试验中，nivolumab被证明是一种有效的治疗选择，对于重度预治疗的晚期GC患者具有相对安全的特征。
Gastric cancer (GC) is still the third leading cause of cancer death in both sexes worldwide. Helicobacter pylori infection is the most important risk factor for GC and, in spite of the consistent trend of a decreasing incidence, in 2015 approximately 4.4billion individualsmore than half the world's populationwere infected with H.pylori. The birth cohort pattern of decreased H.pylori infection reported in a systematic review contributes to explain the declining GC mortality in Japan. Current trends in estimated annual percentage change of GC incidence foreshadow expected reversals in both falling incidence and male predominance among US non-Hispanic whites. Combining serum pepsinogen 1 and H.pylori serology was shown to be useful for GC risk stratification in a Finnish population. Gastritis staging by operative link on gastritis assessment was confirmed to be reliable in predicting GC risk in a large prospective study. In a randomized trial from South Korea, H.pylori eradication therapy significantly reduced the rates of metachronous GC in patients who received curative endoscopic resection for early GC. A study based on a territory-wide health care database of the Hong Kong Hospital Authority showed that aspirin use is associated with a reduced GC risk. Another study based on the same database showed that proton pump inhibitors increase GC risk, but methodological biases have most likely acted as confounders. Confirmatory data on the role of endoscopic submucosal dissection in patients with early GC have been published. The phase III FLOT4 trial has shown that the FLOT triplet regimen (docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil) improves the outcome of patients with GC and locoregional disease as compared to the ECF triplet (epirubicin, cisplatin, and 5-fluorouracil). In the phase III ATTRACTION-2 trial, nivolumab was shown to be an effective treatment option with a relative safe profile for heavily pretreated patients with advanced GC.