同时性多发性胃癌的诊疗进展
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摘要
同时性多发性胃癌是指胃内不同部位同时出现2个及以上的独立肿瘤,是一种较为少见的胃癌类型,约占胃癌总发病率的6%～14%。目前,多发性胃癌分为单克隆起源及多克隆起源多发性胃癌,部分肿瘤存在遗传易感性和错配修复基因突变。多发性胃癌多见于老年男性,好发于近端胃,早期胃癌多见,与单发性胃癌相比,其脉管癌栓、分化及淋巴结转移情况等临床病理特征方面均无显著性差异。根据分期及发病位置不同,多发性胃癌患者可行内镜下局部切除、部分胃切除和全胃切除等治疗方法。对于存在遗传易感性的多发性胃癌患者,是否需行扩大性胃切除术则需进一步探讨。
Synchronous multiple gastric cancer is a rare condition involving multiple malignant tumors at different sites in the stomach. Such cases account for 6%-14% of all gastric cancers. Currently, cases of multiple gastric cancer can be classified by the monoclonal or polyclonal nature of the original tumor. Some patients with multiple gastric cancer exhibit hereditary susceptibility and mutations in mismatch repair genes. Multiple gastric cancer occurs more commonly among elderly male patients and in the proximal stomach at an early stage. No significant differences in vascular invasion, differentiation status, and lymph node metastasis have been identified between solitary and multiple gastric cancers. Several treatment approaches for multiple gastric cancer have been applied clinically, including endoscopic resection and subtotal and total gastric resection according to the tumor stages and sites. Further discussion is needed regarding the extension of gastric resection for multiple gastric cancer in patients with hereditary susceptibility.
Synchronous multiple gastric cancer is a rare condition involving multiple malignant tumors at different sites in the stomach. Such cases account for 6%-14% of all gastric cancers. Currently, cases of multiple gastric cancer can be classified by the monoclonal or polyclonal nature of the original tumor. Some patients with multiple gastric cancer exhibit hereditary susceptibility and mutations in mismatch repair genes. Multiple gastric cancer occurs more commonly among elderly male patients and in the proximal stomach at an early stage. No significant differences in vascular invasion, differentiation status, and lymph node metastasis have been identified between solitary and multiple gastric cancers. Several treatment approaches for multiple gastric cancer have been applied clinically, including endoscopic resection and subtotal and total gastric resection according to the tumor stages and sites. Further discussion is needed regarding the extension of gastric resection for multiple gastric cancer in patients with hereditary susceptibility.
引文
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[27] Miyoshi E, Haruma K, Hiyama T, et al. Microsatellite instability is a genetic marker for the development of multiple gastric cancers[J]. Int J Cancer, 2001, 95(6):350-353.
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[29] Huguier M, Ferro L, Barrier A, et al. Early gastric carcinoma:spread and multicentricity[J]. Gastric cancer, 2002, 5(3):125-128.
[30] Kapadia CR. Gastric atrophy, metaplasia, and dysplasia:a clinical perspective[J]. J Clin Gastroenterol, 2003, 36(5 Suppl):S29-36.
[31] Takeuchi D, Koide N, Suzuki A, et al. High incidence of other primary malignancies in patients with synchronous multiple gastric cancers"a multi-center retrospective cohort study"[J]. Oncotarget, 2018, 9(29):20605-20616.
[2] Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008[J]. Int J cancer, 2010, 127(12):2893-2917.
[3] Jemal A, Center MM, De Santis C, et al. Global patterns of cancer incidence and mortality rates and trends[J]. Cancer Epidemiology,Biomarkers Prev, 2010, 19(8):1893-1907.
[4] Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012[J]. CA Cancer J Clin,2015, 65(2):87-108.
[5] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J].CA Cancer J Clin, 2016, 66(2):115-132.
[6]叶颖江,郭鹏,王杉.胃癌综合治疗的现状与展望[J].中国肿瘤临床,2012,39(20):1475-1480.
[7] Morgagni P, Marfisi C, Gardini A, et al. Subtotal gastrectomy as treatment for distal multifocal early gastric cancer[J]. J Gastrointest Surg, 2009, 13(12):2239-2244.
[8] Moertel CG, Bargen JA, Soule EH, et al. Multiple gastric cancers:review of the literature and study of 42 cases[J]. Gastroenterology, 1957, 32(6):1095-1103.
[9] Yoo JH, Shin SJ, Lee KM, et al. How can we predict the presence of missed synchronous lesions after endoscopic submucosal dissection for early gastric cancers or gastric adenomas[J]? J Clin Gastroenterol,2013, 47(2):e17-22.
[10] Jeong SH, An J, Kwon KA, et al. Predictive risk factors associated with synchronous multiple early gastric cancer[J]. Medicine, 2017, 96(26):e7088.
[11] Shi Q, Sun D, Cai SL, et al. Clinical analysis of endoscopic submucosal dissection for the synchronous multiple primary early cancers in esophagus and stomach:12 cases report[J]. J Laparoendosc Adv Surg Tech A, 2018, 28(9):1068-1073.
[12] Xing X, Jia S, Wu J, et al. Clonality analysis of synchronous gastro-oesophageal junction carcinoma and distal gastric cancer by wholeexome sequencing[J]. J Pathol, 2017, 243(2):165-175.
[13] Shinmura K, Sugimura H, Naito Y, et al. Frequent cooccurrence of mutator phenotype in synchronous, independent multiple cancers of the stomach[J]. Carcinogenesis, 1995, 16(12):2989-2993.
[14] Mizuguchi A, Takai A, Shimizu T, et al. Genetic features of multicentric/multifocal intramucosal gastric carcinoma[J]. Int J Cancer, 2018, 143(8):1923-1934.
[15] Huntsman DG, Carneiro F, Lewis FR, et al. Early gastric cancer in young,asymptomatic carriers of germ-line E-cadherin mutations[J]. New Engl J Med, 2001, 344(25):1904-1909.
[16] Kodera Y, Yamamura Y, Torii A, et al. Incidence, diagnosis and significance of multiple gastric cancer[J]. Br J Surg, 1995, 82(11):1540-1543.
[17] Otsuji E, Kuriu Y, Ichikawa D, et al. Clinicopathologic characteristics and prognosis of synchronous multifocal gastric carcinomas[J]. Am J Surg,2005, 189(1):116-119.
[18] Kitamura K, Yamaguchi T, Okamoto K, et al. Clinicopathologic features of synchronous multifocal early gastric cancers[J]. Anticancer Res,1997, 17(1b):643-646.
[19] Eom BW, Lee JH, Choi IJ, et al. Pretreatment risk factors for multiple gastric cancer and missed lesions[J]. J Surg Oncol, 2012, 105(8):813-817.
[20] Kim HM, Kim HK, Lee SK, et al. Multifocality in early gastric cancer does not increase the risk of lymph node metastasis in a single-center study[J]. Ann Surg Oncol, 2012, 19(4):1251-1256.
[21] Ihamaki T, Saukkonen M, Siurala M, et al. Long-term observation of subjects with normal mucosa and with superficial gastritis:results of23-27 years'follow-up examinations[J]. Scand J Gastroenterol, 1978,13(7):771-775.
[22] Sinicrope FA. Lynch syndrome-associated colorectal cancer[J]. New Engl J Med, 2018, 379(8):764-773.
[23]郭琳,杨腾飞,张萌,等.胃多发癌11例的诊断及治疗分析[J].中国医师杂志,2013,15(3):338-340.
[24] Borie F, Plaisant N, Millat B, et al. Treatment and prognosis of early multiple gastric cancer[J]. EurJ Surg Oncol, 2003, 29(6):511-514.
[25] Kim JH, Jeong SH, Yeo J, et al. Clinicopathologic similarities of the main and minor lesions of synchronous multiple early gastric cancer[J]. J Korean Med Sci, 2016, 31(6):873-878.
[26]陈虹彬,徐辉,蒋明德,等.四川成都:胃镜诊断食管胃多发灶癌23例报告[J].四川医学,2002,23(11):1137-1138.
[27] Miyoshi E, Haruma K, Hiyama T, et al. Microsatellite instability is a genetic marker for the development of multiple gastric cancers[J]. Int J Cancer, 2001, 95(6):350-353.
[28]王征,周志祥,梁建伟,等.胃多发癌的外科治疗及预后分析[J].中华医学杂志,2009,89(38):2705-2707.
[29] Huguier M, Ferro L, Barrier A, et al. Early gastric carcinoma:spread and multicentricity[J]. Gastric cancer, 2002, 5(3):125-128.
[30] Kapadia CR. Gastric atrophy, metaplasia, and dysplasia:a clinical perspective[J]. J Clin Gastroenterol, 2003, 36(5 Suppl):S29-36.
[31] Takeuchi D, Koide N, Suzuki A, et al. High incidence of other primary malignancies in patients with synchronous multiple gastric cancers"a multi-center retrospective cohort study"[J]. Oncotarget, 2018, 9(29):20605-20616.