Characteristics and predictors of gastric cancer after Helicobacter pylori eradication.
Characteristics and predictors of gastric cancer after Helicobacter pylori eradication.
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DOI：
10.3748/wjg.v24.i20.2163
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发表时间：
2018-05-28
影响因子：
4.3
通讯作者：
Hirata Y
中科院分区：
文献类型：
--
作者：
Shichijo S;Hirata Y
根除幽门螺杆菌可以减少胃癌的发生。然而，胃癌在根除后仍在发展，接受根除治疗的病例正在增加。在这项研究中，我们回顾了幽门螺杆菌根除后发生的原发胃癌的特点和预测因素。在特征方面，报告了内窥镜、组织学和分子特征。胃镜下，根除后的胃癌多为凹陷型，表现为胃炎样表现，有时诊断困难。组织学上，胃癌根治后多为肠型，肿瘤周围常可见非肿瘤性上皮，又称低度异型性上皮，可能是胃镜下出现胃炎样表现的原因。至于分子特征，一些标志物，如Ki67、MUC2和Wnt5a在根除幽门螺杆菌的癌症患者中的表达较低。在预测因素方面，日本的几项研究报告称，根除时严重的内窥镜萎缩是胃癌发展的危险因素。幽门螺杆菌根除后，组织学上的肠化生，特别是肠体上皮化生，以及质子泵抑制剂的长期使用，也被报道为胃癌的危险因素。这些关于胃癌发展的特征和预测因素的研究将成为建立一种新的监测计划的基石，该计划基于针对幽门螺杆菌根除患者的胃癌风险分层。
Helicobacter pylori (H. pylori) eradication can reduce gastric cancer. However, gastric cancer still develops after eradication, and cases who received eradication therapy are increasing. In this study, we have reviewed the characteristics and predictors of primary gastric cancer developing after H. pylori eradication. In terms of the characteristics, endoscopic, histologic, and molecular characteristics are reported. Endoscopically, gastric cancer after eradication is often depressed-type and shows a gastritis-like appearance, which sometimes makes the diagnosis difficult. Histologically, most gastric cancer after eradication is intestinal type, and non-neoplastic epithelium, also called epithelium with low-grade atypia, is frequently seen over the tumor, which is presumably the cause of the endoscopic gastritis-like appearance. As for molecular characteristics, some markers, such as Ki67, MUC2, and Wnt5a expression, are lower in cancer from patients in whom H. pylori has been eradicated. In terms of predictors, several Japanese studies have reported that severe endoscopic atrophy at eradication is a risk factor for gastric cancer development. Histologic intestinal metaplasia, especially in the corpus, and long-term use of proton pump inhibitors, are also reported as risk factors for gastric cancer after H. pylori eradication. These studies on the characteristics and predictors of gastric cancer development will become the cornerstone for establishing a novel surveillance program based on the gastric cancer risk stratification specific to H. pylori-eradicated patients.
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影响因子：
4.1
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