Heterogeneity in Gastric Cancer: From Pure Morphology to Molecular Classifications
Heterogeneity in Gastric Cancer: From Pure Morphology to Molecular Classifications
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DOI：
10.1159/000473881
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发表时间：
2018-01-01
期刊：
影响因子：
5
通讯作者：
Almeida, Gabriela M.
中科院分区：
文献类型：
--
作者：
Gullo, Irene;Carneiro, Fatima;Almeida, Gabriela M.
胃癌（GC）是一个全球性的健康问题。尽管在预防、诊断和治疗方面取得了进展，但GC仍然是全球癌症死亡的第三大原因，2012年估计有超过720，000人死亡。晚期疾病的总生存期约为1年，预后不佳，部分原因是GC中发现的高水平生物异质性。事实上，从形态学和分子学的角度来看，GC是一种高度异质性的疾病。目前可用的众多组织学和分子分类反映了这种异质性。尽管最近的高通量研究将获得的分子数据聚类为具有临床相关性的亚组，但我们仍然需要一个实用的、预后的和预测性的分类系统，该系统整合了形态学和分子特征，以鉴定新的治疗靶点。值得注意的是，GC异质性不仅包括患者间的变异性（肿瘤间异质性），还包括同一肿瘤内的变异性（肿瘤内异质性）。后者包括空间异质性（在不同的肿瘤区域）和时间异质性（沿着从原发性到复发性和/或转移性疾病的进展）。在这篇综述中，我们分析了GC的形态学，免疫表型和分子异质性作为更好地了解疾病的基础，并讨论了诊断病理学，预后评估和精确治疗的实际意义。(C)2017 S. Karger AG，巴塞尔。
Gastric cancer (GC) represents a global health concern. Despite advances in prevention, diagnosis, and therapy, GC is still the third leading cause of cancer mortality worldwide, with more than 720,000 estimated deaths in 2012. Overall survival for advanced disease is about 1 year, a dismal prognosis that is partly due to the high levels of biological heterogeneity found in GC. Indeed, GC is a highly heterogeneous disease from morphological and molecular standpoints. The numerous histological and molecular classifications currently available reflect such heterogeneity. Although recent high-throughput studies cluster the molecular data obtained into subgroups with clinical relevance, we still need a practical, prognostic, and predictive classification system, integrating morphological and molecular features, towards the identification of novel therapeutic targets. It is noteworthy that GC heterogeneity encompasses not only interpatient variability (intertumour heterogeneity), but also variations within the same tumour (intratumour heterogeneity). The latter encompasses spatial heterogeneity (in different tumour areas) and temporal heterogeneity (along progression from primary to recurrent and/or metastatic disease). In this review, we analyse the morphological, immunophenotypic, and molecular heterogeneity in GC as the basis for a better understanding of the disease, and discuss the practical implications for diagnostic pathology, prognostic evaluation, and precision therapy. (C) 2017 S. Karger AG, Basel.