胃癌临床综合治疗模式初探

目的探讨规范化治疗方案在胃癌临床治疗中的作用和意义。方法收集2010年2月-2011年3月所诊治的52例胃癌患者,采用临床规范化治疗,总结其临床病理资料、治疗过程。结果 3例术前证实转移的未作手术,行姑息治疗;1例术前分期T1直接行手术;48例治疗前预行腹腔镜探查,15例探查发现腹膜转移,证实为M1,行热灌注化疗,然后姑息化疗,后期可耐受姑息手术10例,其余33例患者根据术前拟定程序行直接手术15例,先行新辅助化疗、评效后再手术18例,所有手术均达D2标准。手术住院时间7～70 d,平均11 d。手术时间120～190 min,平均145 min。术中出血约50～200 mL,平均125 mL。结论重视胃癌临床综合治疗模式,对于规范胃癌治疗,为患者选择合理有效的治疗方式具有重要的临床意义。     

Characteristics and consequences of missed gastric cancer: A multicentric cohort study

BackgroundMissed gastric cancer (MGC) is poorly documented in Mediterranean populations.Aims(1) To assess the rate, predictors and survival of MGC. (2) To compare MGC and non-MGC tumors.MethodsThis is a retrospective-cohort study conducted at four centers. MGC was defined as cancer detected within three years after negative esophagogastroduodenoscopy. Gastric adenocarcinomas diagnosed between 2008–2015 were included. Patients with no follow-up were excluded.ResultsDuring the study period 123,395 esophagogastroduodenoscopies were performed, with 1374 gastric cancers being diagnosed (1.1%). A total of 1289 gastric cancers were finally included. The overall rate of MGC was 4.7% (61/1289, 3.7–6%). A negative esophagogastroduodenoscopy in MGC patients was independently associated with PPI therapy (p < 0.001), previous Billroth II anastomosis (p = 0.002), and lack of alarm symptoms (p < 0.001). The most frequent location for MGC was the gastric body(52.4%). MGCs were smaller than non-MGCs (31 vs 41 mm, p = 0.047), more often flat or depressed (p = 0.003) and less likely to be encountered as advanced disease. Overall 2-year survival was similar between MGC (34.1%) and Non-MGC (35.3 %) (p = 0.59).ConclusionMGC accounted for nearly five percent of newly-diagnosed gastric adenocarcinomas. Overall survival was poor and not different between MGC and non-MGC.     

维生素与胃癌的预防

胃癌是常见的消化系肿瘤,2002年全球因胃癌而死亡的患者超过700,000例,居各种肿瘤死亡率的第二位[1].目前已经普遍接受的胃癌发生模式是癌前病变(萎缩性胃炎、肠化生、不典型增生)→恶性肿瘤.多数患者出现症状而就医时,肿瘤往往已侵润至肌层,手术和化疗效果欠佳.     

Disease burden of gastric cancer in Jinchang cohort

<正>Objective To understand the current status of disease burden caused by gastric cancer in Jinchang cohort.Methods In this historical cohort study,the data of gastric cancer deaths from 2001 to 2013 and the medical records of gastric cancer cases from 2001 to 2010 in Jinchang cohort were collected to analyze the mortality,po-     

An experimental study of gastric cancer in relation to gastric ulcer

This experimental study shows that carcinogens are relatively harmless on intact gastric mucosa but can induce lesions when the mucosa has been damaged, particularly when the injury is deep as in gastrostomy. Human gastric carcinogenesis is discussed in the light of these findings.     

Prospective cohort comparison of flavonoid treatment in patients with resected colorectal cancer to prevent recurrence

AIM： To investigate biological prevention with flavonoids the recurrence risk of neoplasia was studied in patients with resected colorectal cancer and after adenoma polypectomy. METHODS： Eighty-seven patients, 36 patients with resected colon cancer and 51 patients after polypectomy, were divided into 2 groups： one group was treated with a flavonoid mixture （daily standard dose 20 mg apigenin and 20 mg epigallocathechin-gallat, n = 31） and compared with a matched control group （n = 56）. Both groups were observed for 3-4 years by surveillance colonoscopy and by questionnaire. RESULTS： Of 87 patients enrolled in this study, 36 had resected colon cancer and 29 of these patients had surveillance colonoscopy. Among the flavonoid-treated patients with resected colon cancer （n = 14）, there was no cancer recurrence and one adenoma developed. In contrast the cancer recurrence rate of the 15 matched untreated controls was 20% （3 of 15） and adenomas evolved in 4 of those patients （27%）. The combined recurrence rate for neoplasia was 7% （1 of 14） in the treated patients and 47% （7 of 15） in the controls （P = 0.027）. CONCLUSION： Sustained long-term treatment with a flavonoid mixture could reduce the recurrence rate of colon neoplasia in patients with resected colon cancer.     

Asia-Pacific consensus guidelines on gastric cancer prevention

Background and Aim: Gastric cancer is a major health burden in the Asia–Pacific region but consensus on prevention strategies has been lacking. We aimed to critically evaluate strategies for preventing gastric cancer. Methods: A multidisciplinary group developed consensus statements using a Delphi approach. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Results: Helicobacter pylori infection is a necessary but not sufficient causal factor for non‐cardia gastric adenocarcinoma. A high intake of salt is strongly associated with gastric cancer. Fresh fruits and vegetables are protective but the use of vitamins and other dietary supplements does not prevent gastric cancer. Host–bacterial interaction in H. pylori infection results in different patterns of gastritis and differences in gastric acid secretion which determine disease outcome. A positive family history of gastric cancer is an important risk factor. Low serum pepsinogens reflect gastric atrophy and may be useful as a marker to identify populations at high risk for gastric cancer. H. pylori screening and treatment is a recommended gastric cancer risk reduction strategy in high‐risk populations. H. pylori screening and treatment is most effective before atrophic gastritis has developed. It does not exclude the existing practice of gastric cancer surveillance in high‐risk populations. In populations at low risk for gastric cancer, H. pylori screening is not recommended. First‐line treatment of H. pylori infection should be in accordance with national treatment guidelines. Conclusion: A strategy of H. pylori screening and eradication in high‐risk populations will probably reduce gastric cancer incidence, and based on current evidence is recommended by consensus.     

Acceptance of repeat esophagogastroduodenoscopy to detect gastric cancer in a Chinese immigrant cohort

GOAL: To study the feasibility of using repeat esophagogastroduodenoscopy (EGD) to screen for Helicobacter pylori infection and gastric cancer in an Asian immigrant cohort. BACKGROUND: Immigrants in the United States (US) from countries with high per capita rates of gastric cancer remain at higher risk for gastric cancer. The existence of the possibly modifiable risk factor of H. pylori infection and the poor outcomes associated with late-stage disease make screening higher-risk groups with EGD an appealing possibility. It is unknown whether Asian immigrants in the US would accept an EGD-based strategy for gastric cancer screening. STUDY: Cross-sectional study of adult Chinese immigrants in New York City with dyspepsia who underwent EGD in an earlier gastric cancer detection study, who were offered a second EGD four years later. Our main outcome measure was acceptance or refusal of repeat EGD. RESULTS: Seventy-three of the 115 Chinese participants in the earlier study were successfully contacted for this current study. Twenty-three of 73 (32%) underwent repeat EGD. Leading reasons given for declining were lack of symptoms and lack of time. Significantly associated with acceptance of repeat EGD was the belief that EGD will find stomach cancer "nearly always" in someone who has it (P=0.0054; odds ratio=14.0, 2.1 to 94.2 95% confidence interval). CONCLUSIONS: Acceptance of repeat EGD for gastric cancer detection in a cohort of Chinese immigrants was relatively low despite the mitigation of cost and language factors, 2 major barriers to healthcare access. Relocation seemed to be a factor as well. In this population, perceptions of the benefits of EGD may influence acceptance of testing for cancer detection purposes.     

Incidence and prognosis of gastric cancer in a population-based cohort survey: the Hisayama study

BACKGROUND: No population-based cohort studies have been undertaken to evaluate the incidence and prognosis of gastric cancer. The purpose of this investigation was to clarify the incidence and fatal prognosis of gastric cancer and to determine the factors that contribute to the prognosis in a general Japanese population in Hisayama using a prospective study design. METHODS: From 1988 to 1998 a total of 2605 subjects aged 40 years or older with no history of gastrectomy or gastric cancer were followed-up prospectively after a health examination. The diagnosis of gastric cancer was based on clinical records or autopsy findings. RESULTS: During the follow-up period, 76 subjects developed gastric cancer. The age-adjusted incidence of gastric cancer for men (4.9 per 1000 person-years) was 4-fold higher than that for women (1.2, P < 0.05). In men, the incidence of gastric cancer increased with advancing age, but this trend was not observed in women. The age- and sex-adjusted 5-year survival rate was significantly higher in cancers of the middle third of the stomach than in those of the upper third of the stomach. The survival rate was higher in cancers of well-differentiated adenocarcinoma than in those of the other histological types. There were no cases of cancer-related death among the early gastric cancers during the follow-up period. CONCLUSIONS: Our data suggest that men are at higher risk of gastric cancer than women in the general Japanese population. Clinical stage, histological type, and site of cancer in the stomach contribute to a fatal prognosis.     

Non-steroidal anti-inflammatory drugs in prevention of gastric cancer

Non-steroidal anti-inflammatory drugs (NSAIDs) including cyclooxygenase 2 (COX-2) selective inhibitors, are potential agents for the chemoprevention of gastric cancer. Epidemiological and experimental studies have shown that NSAID use is associated with a reduced risk of gastric cancer although many questions remain unanswered such as the optimal dose and duration of treatment. The possible mechanisms for the suppressor effect of NSAIDs on carcinogenesis are the ability to induce apoptosis in epithelial cells and regulation of angiogenesis. Both COX-dependent and COX independent pathways have a role in the biological activity of NSAIDs. Knowledge of how NSAIDs prevent neoplastic growth will greatly aid the design of better chemopreventive drugs and novel treatments for gastric cancer.     

Novel strategies in the prevention of gastric cancer

Helicobacter pylori has been classified as a human carcinogen contributing to the pathogenesis of gastric cancer. Eradication of H. pylori as a means towards preventing gastric cancers has become an interesting option, however, the scientific data supporting this practice are not well established. Therefore, large, multicenter trials have been initiated in order to assess and establish the scientific basis for this option. Reverting histomorphological and biochemical changes of the gastric mucosa after H. pylori eradication point to a beneficial effect of H. pylori eradication on the prevention of gastric cancers. This article will give a brief overview on the current knowledge on the pathogenesis of gastric cancer and the role of H. pylori in this regard and will also describe current approaches towards preventing gastric cancer.     

Treatment of Helicobacter pylori and prevention of gastric cancer

Gastric cancer is the second commonest fatal malignancy in the world with a high incidence in China. Helicobacter pylori infection is an important factor in the pathogenesis of gastric cancer. Epidemiological studies have shown a strong causal relationship between H. pylori infection and gastric cancer. Animal studies also show that eradication of H. pylori infection, especially at the early stage, is effective in preventing H. pylori-related gastric carcinogenesis. H. pylori eradication leads to regression and prevents the progression of gastric precancerous lesions, but only in a minority of cases. H. pylori eradication appears to be the most promising approach in gastric cancer prevention. The current available data in human studies showed that H. pylori eradication can reduce the risk of developing gastric cancer and this strategy is more useful in patients without atrophic gastritis or intestinal metaplasia. A longer follow-up and additional studies are needed for better understanding this issue.     

Helicobacter pylori and the prevention of gastric cancer.

BACKGROUND: Helicobacter pylori is an important cause of stomach cancer that infects a substantial proportion of the Canadian adult population. H pylori can be detected by noninvasive tests and effectively eradicated by medical treatment. Screening for and treatment of H pylori may represent a significant opportunity for preventive oncology. METHODS: Cancer Care Ontario organized a workshop held in Toronto, Ontario, on October 24 and 25, 2002, to: review the current state of knowledge regarding H pylori treatment and cancer prevention; determine if there is currently sufficient evidence to consider the promotion of H pylori treatment for the purpose of cancer prevention; identify critical areas for research; and advise Cancer Care Ontario on H pylori and cancer prevention. RESULTS: Workshop participants developed a number of recommendations for research into the relationship between H pylori and stomach cancer, including determining the prevalence of infection in different regions of Canada, the pathogenetic sequence of carcinogenesis from H pylori infection, and the implementation of a prospective observational study. INTERPRETATION: Although the rate of H pylori infection is declining in Canada and the treatment of H pylori is generally accepted to be safe, the evidence to date may not warrant the implementation of population screening for H pylori infection to prevent gastric carcinoma in average-risk populations. Rather, a demonstration project is needed to estimate prevalence, evaluate the merits of screening, measure patient compliance and physician participation, develop education materials, establish a registry for monitoring and evaluation, and develop a quality assurance framework.