Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
复制标题
DOI：
10.1093/annonc/mdw350
复制
发表时间：
2016-09-01
影响因子：
50.5
通讯作者：
Arnold, D.
中科院分区：
文献类型：
--
作者：
Smyth, E. C.;Verheij, M.;Arnold, D.
2012年，全球诊断出近100万（951，600）例新发胃癌病例，导致723，100例死亡[1]。在这些病例中，140 000例和107 000例死亡发生在欧洲[2]。胃癌的发病率在全球范围内存在显著差异;东亚、东欧和南美的发病率最高，北美和西欧的发病率较低。在过去60年里，西欧和北美的胃癌发病率逐渐下降，最近在高发病率国家的下降也变得明显。在流行病学上，这与胃食管交界处肿瘤的相对增加不同，后者在单独的指南文件中进行了讨论。胃癌的风险因素包括男性（发病率是男性的两倍）、幽门螺杆菌感染、吸烟、萎缩性胃炎、胃部分切除术和Ménétrier病[3]。胃癌危险因素的区域差异影响了疾病最常见的解剖亚部位。远端或胃窦癌与H。幽门螺杆菌感染、饮酒、高盐饮食、加工肉类以及水果和蔬菜摄入量低在东亚更为常见。近端胃（贲门）肿瘤与肥胖相关，胃食管交界处肿瘤与反流和Barrett食管相关，在非亚洲国家更常见[4]。胃癌在约10%的病例中表现出家族聚集性，在小部分病例中发现了遗传性遗传易感性（约1%-3%）;相关综合征包括遗传性非息肉病性结直肠癌、家族性腺瘤性息肉病性结直肠癌、遗传性弥漫性胃癌（HDGC）、胃腺癌和胃近端息肉病（GAPPS）和Peutz Jegher综合征[5，6]。如果怀疑存在家族性癌症综合征（如HDGC），建议根据国际临床指南[V，B][7]转诊至遗传学家进行评估。
Almost one million (951 600) new cases of gastric cancer were diagnosed globally in 2012, resulting in∼ 723 100 deaths [1]. Of these∼ 140 000 cases and∼ 107 000 deaths occurred in Europe [2]. Gastric cancer displays significant global variation in incidence; the highest rates are seen in Eastern Asia, Eastern Europe and South America, with lower rates in North America and Western Europe. A gradual decline in the incidence of gastric cancer has been observed in Western Europe and North America over the past 60 years and more recent declines in high-prevalence countries have also become apparent. This is epidemiologically distinct from the relative increase in tumours of the gastroesophageal junction, which are discussed in a separate guideline document.Risk factors for gastric cancer include male gender (incidence is twice as high), Helicobacter pylori infection, tobacco use, atrophic gastritis, partial gastrectomy and Ménétrier's disease [3]. Regional variation in gastric cancer risk factors influences the most common anatomical subsites of disease. Distal or antral gastric cancers that are associated with H. pylori infection, alcohol use, high-salt diet, processed meat and low fruit and vegetable intake are more common in East Asia. Tumours of the proximal stomach (cardia) are associated with obesity, and tumours of the gastroesophageal junction are associated with reflux and Barrett's oesophagus and are more common in non-Asian countries [4]. Gastric cancer demonstrates familial aggregation in∼ 10% of cases, and an inherited genetic predisposition is found in a small proportion of cases (∼ 1%–3%); relevant syndromes include hereditary non-polyposis colorectal cancer, familial adenomatous polyposis colorectal cancer, hereditary diffuse gastric cancer (HDGC), gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) and Peutz Jegher's syndrome [5, 6]. If a familial cancer syndrome such as HDGC is suspected, referral to a geneticist for assessment is recommended based on international clinical guidelines [V, B][7].