早期胃癌的治疗现状与进展

胃癌是常见的消化道肿瘤之一,是我国死亡率最高的恶性肿瘤之一。与日本韩国等发达国家相比,我国胃癌患者多数在就诊时已处于进展期,早期胃癌所占比例不足10%。传统的开腹胃癌手术仍是治疗早期胃癌的主要手段。相较于传统开腹手术,腹腔镜手术对于早期胃癌的治疗优势是显而易见的。早期胃癌患者行腹腔镜手术,具有术后恢复快,生活质量好,近期疗效佳等优势。内镜黏膜下剥离术(ESD,endoscopic submucosal dissection)是近年来出现的一项新的治疗早期胃癌的手段。本文就传统开腹手术、腹腔镜手术及ESD分别在早期胃癌治疗中的应用进行了综述。微创手术治疗早期胃癌将逐渐代替开腹手术,成为早期胃癌治疗的主要手段。     

Experimental gastric carcinogenesis in Cebus apella nonhuman primates

The evolution of gastric carcinogenesis remains largely unknown. We established two gastric carcinogenesis models in New-World nonhuman primates. In the first model, ACP03 gastric cancer cell line was inoculated in 18 animals. In the second model, we treated 6 animals with N-methyl-nitrosourea (MNU). Animals with gastric cancer were also treated with Canova immunomodulator. Clinical, hematologic, and biochemical, including C-reactive protein, folic acid, and homocysteine, analyses were performed in this study. MYC expression and copy number was also evaluated. We observed that all animals inoculated with ACP03 developed gastric cancer on the 9(th) day though on the 14(th) day presented total tumor remission. In the second model, all animals developed pre-neoplastic lesions and five died of drug intoxication before the development of cancer. The last surviving MNU-treated animal developed intestinal-type gastric adenocarcinoma observed by endoscopy on the 940(th) day. The level of C-reactive protein level and homocysteine concentration increased while the level of folic acid decreased with the presence of tumors in ACP03-inoculated animals and MNU treatment. ACP03 inoculation also led to anemia and leukocytosis. The hematologic and biochemical results corroborate those observed in patients with gastric cancer, supporting that our in vivo models are potentially useful to study this neoplasia. In cell line inoculated animals, we detected MYC immunoreactivity, mRNA overexpression, and amplification, as previously observed in vitro. In MNU-treated animals, mRNA expression and MYC copy number increased during the sequential steps of intestinal-type gastric carcinogenesis and immunoreactivity was only observed in intestinal metaplasia and gastric cancer. Thus, MYC deregulation supports the gastric carcinogenesis process. Canova immunomodulator restored several hematologic measurements and therefore, can be applied during/after chemotherapy to increase the tolerability and duration of anticancer treatments.     

胃肠安对胃癌细胞氧化应激及炎症活化的影响

目的：观察中药胃肠安对胃癌细胞的丙二醛（MDA）、超氧化物岐化酶（SOD）、乳酸脱氢酶（LDH）及核转录因子NF-KB表达的影响,并探讨胃肠安在胃癌微环境中氧化应激及炎症活化的作用。方法：获取胃肠安药物血清,以胃癌细胞（SGC-7901细胞株）为研究对象,设对照组和胃肠安处理组,检测胃癌细胞SOD、MDA、LDH的水平,WesternBlot检测胃癌细胞NF—KB蛋白的表达。结果：与对照组相比,胃肠安处理组中胃癌细胞MDA、LDH降低,而SOD水平升高;对照组胃癌细胞NF-KB蛋白相对表达量为（0．68±0．12）,与对照组相比,胃肠安处理组胃癌细胞NF—KB蛋白相对表达量（0．36±0．04）降低。结论：胃肠安可通过抑制胃癌细胞的氧化应激和炎症,改变肿瘤细胞生存微环境,最终可能发挥抑制肿瘤生长的作用,其具体效应有待深入研究。     

GPR177 promotes gastric cancer proliferation by suppressing endoplasmic reticulum stress-induced cell death

Gastric cancer is the fourth most common cancer worldwide. Despite the high incidence of gastric cancer, efficient chemotherapy treatments still need to be developed. In this study, we examined the anticancer effects of endoplasmic reticulum (ER) stress inducer tunicamycin in gastric cancer. Previously, we found that overexpression of WLS1/GPR177 correlated with poor prognosis in patients with gastric cancer. Furthermore, tunicamycin treatment downregulated GPR177 expression in a dose-dependent manner. GPR177 transports WNT ligand from ER to the plasma membrane, mediating its secretion to the extracellular matrix. In gastric cancer cells, GPR177 preferentially localizes to the ER. Small interfering RNA-mediated knockdown of GPR177 leads to sensitization to ER stress and induces apoptosis of cancer cells along with tunicamycin treatment. GPR177 suppression promoted the ER stress-mediated proapoptotic pathway, such as PERK-CHOP cascade. Furthermore, fluorouracil treatment combined with tunicamycin dramatically reduced cancer cell proliferation. Efficacy of tunicamycin chemotherapy treatments depended on GPR177 expression in gastric cancer cell lines. Together, our results indicate that ER stress can potentiate anticancer effects and suggest GPR177 as a potential gastric cancer therapeutic target.     

Gastric cancer: clinical aspects, epidemiology and molecular background

The validity and usefulness of the 7th edition of the UICC tumor node metastasis classification in the context of clinical management of gastric cancer are discussed. The most relevant new agent in gastric cancer therapy is trastuzumab for HER2-positive gastric carcinomas. This marks the success of continuous effort of translational research. Trastuzumab, initially applied in palliative settings, is currently being evaluated also in neoadjuvant treatment regimens. Several new meta-analyses support the carcinogenic effect of high salt intake and smoking in the context of Helicobacter pylori infection. Further data have become available on the efficacy of protective agents, acetyl salicylic acid/nonsteroidal anti-inflammatory drugs, and antioxidants. In search for a successful prevention strategy, the focus is on the identification of individuals at high risk who demand screening (testing) and surveillance. Serological assessment of gastric mucosal abnormalities with increased risk for gastric cancer development is extensively studied, and new data are presented from Asia as well as from Europe. New high-throughput techniques combined with bioinformatic vector analysis open the gate to the identification of new potential diagnostic and therapeutic targets. Furthermore, these approaches allow us to elucidate the interplay of bacterial virulence factors and the host's immune response as well as H. pylori-associated alterations of mucosal gene expression.     

应用siRNA干扰胃癌的研究进展

胃癌是消化系统最常见的恶性肿瘤,而我国是胃癌高发区,其发病率和死亡率均高于世界平均水平。在我国大多数患者明确诊断时已进入进展期,所以大多数患者再行手术切除后还需放化疗治疗。近来随着对胃癌的研究深入,可通过对胃癌肿瘤标本行分子检测给予患者药物靶向治疗,实现个体化治疗。RNA干涉(RNAi)技术被广泛用于基因功能的研究,并且在哺乳动物研究中得到飞速发展.si RNA是在RNAi中起中心作用,其可抑制特定m RNA,以调节不同蛋白在肿瘤发生时的异常表达。对si RNA的研究将为胃癌的基因治疗供更广阔的空间。     

Gene deregulation in gastric cancer

Despite its decreasing frequency in the Western world during recent decades, gastric cancer is still one of the leading causes of cancer-related deaths worldwide. Due to the oligosymptomatic course of early gastric cancer, most cases are diagnosed in the advanced stages of the disease. The curative potential of current standard treatment continues to be unsatisfactory, despite multimodal approaches involving surgery, chemotherapy and radiotherapy. Novel therapeutics including small molecules and monoclonal antibodies are being developed and have been partially introduced into clinical use in connection with neoplastic diseases such as chronic myeloid leukemia, non-Hodgkin's lymphoma and colorectal cancer. Thorough understanding of the changes in gene expression occurring during gastric carcinogenesis may help to develop targeted therapies and improve the treatment of this disease. Novel molecular biology techniques have generated a wealth of data on up- and down-regulation, activation and inhibition of specific pathways in gastric cancer. Here, we provide an overview of the different aspects of aberrant gene expression patterns in gastric cancer.     

The detection, surveillance and treatment of premalignant gastric lesions related to Helicobacter pylori infection

Gastric cancer is an important worldwide health problem and causes considerable morbidity and mortality. It represents the second leading cause of cancer-related death worldwide. A cascade of recognizable precursor lesions precedes most distal gastric carcinomas. In this multistep model of gastric carcinogenesis, Helicobacter pylori causes chronic active inflammation of the gastric mucosa, which slowly progresses through the premalignant stages of atrophic gastritis, intestinal metaplasia and dysplasia to gastric carcinoma. Detection and treatment of premalignant lesions may thus provide a basis for gastric cancer prevention. However, at present, premalignant changes of the gastric mucosa are frequently disregarded in clinical practice or result in widely varying follow-up frequency or treatment. This review provides an overview of current knowledge on detection, surveillance and treatment of patients with premalignant gastric lesions, and identifies the uncertainties that require further research.     

近端胃切除与全胃切除在治疗近端胃癌中的疗效比较

目的:观察近端胃切除和全胃切除对近端胃癌的疗效。方法:比较28例患有早期近端胃癌接受近端胃切除28例患者与100例患有早期近端胃癌接受全胃切除的患者,观察近端胃切除是否优于全胃切除。结果:两种治疗方法手术时间、术后并发症(包括吻合口瘘)没有差异。两组患者胃切除后的代谢变化结果相似,体重,血清血红蛋白以及血清总蛋白浓度变化相近。近端胃切除后腹泻(32%)和胃食管返流(28%)最为常见,而全胃切除后餐后腹胀(21%)最为常见。二者的术后5年生存率没有明显差别。结论:近端胃切除不会由于残余胃的生理优势而优于全胃切除术。     

Effect of Helicobacter pylori Eradication on Incidence of Gastric Cancer in Human and Animal Models: Underlying Biochemical and Molecular Events

Background:  Gastric cancer remains one of the most common cancers worldwide. A strong association exists between Helicobacter pylori infection and the risk of developing noncardia gastric cancer. H. pylori eradication by antibiotic treatment is regarded as a primary chemoprevention strategy to reduce gastric cancer incidence.
Aim:  To analyze the efficacy of H. pylori eradication in preventing gastric cancer in human and animal models, and to discuss whether biochemical, genetic, and epigenetic changes associated with H. pylori infection are reversible after curing the infection.
Results:  Several intervention trials have indicated that in some patients, H. pylori eradication leads to regression and prevents the progression of precancerous lesions. The eradication therapy reduces gastric cancer incidence in patients without any precancerous lesions at the baseline and is most effective before the development of atrophic gastritis. A few recent intervention studies in Japan have demonstrated significant prophylactic effects of eradication therapy on the development of gastric cancer, suggesting the use of eradication therapy in high-risk populations as a gastric cancer reduction strategy. However, gastric cancer may still develop despite successful eradication therapy. Studies in animal models have confirmed the use of eradication therapy at an early point of infection to prevent gastric cancer development.
Conclusion:  H. pylori eradication may not completely abolish the risk of gastric cancer. However, eradication therapy may be used in high-risk populations to reduce gastric cancer incidence. It can reverse many biochemical, genetic, and epigenetic changes that H. pylori infection induces in the stomach.     

Gastric cancer & prospects of cancer in Saudi Arabia peninsula

Gastric cancer is classified to be an aggressive disease with poor treatment outcome, as most cases remain undetected until later stages, wherein surgery and few chemotherapeutics become the only recommended treatment course. The process of cancer development is multistep involving many stages and types of precancerous lesions, and hence, routine monitoring becomes a necessity in those detected with these or exposed to risk factors. Studying the pattern of gastric cancer for any geographical region is also important to control mortality and focus on implementation of efficient management and treatment guidelines. The cause for gastric cancer can be genetic, racial as well as environmental, and hence the pattern of this malignancy differs across geographical regions and between the developing and the developed nations. In case of the Kindgom of Saudi Arabia, very few hospital-based reports have been published highlighting the pattern of gastric cancer, and the associated incidence and mortality rates. However, classified to be one of the most crucial cancer forms in Saudi Arabia, research pertaining to epidemiology, presentation and pathological features are limited. Studying gastric cancer occurrence from public health viewpoint is important also because eradication of causative agents like those that H. pylori has also shown been not reduce the risk of cancer development among individuals with atrophic metaplastic gastritis. In case of Saudi Arabia, many inherent risks for this malignancy exists like waterpipe smoking and shift in diet pattern from the traditional Mediterranean diet. Our review focusses on pattern of gastric cancer on a global scale in comparison to scenario in Saudi Arabia. The aim is to encompass all of the less stressed upon facts about this malignancy in the Kingdom, paving way for future work in this regards.     

miRNA-181a在胃癌细胞增殖和迁移中的作用

miRNA与恶性肿瘤患者的诊断和预后密切相关,为了考察miRNA-181a在胃癌细胞增殖和迁移中的作用,本研究检测了miRNA-181a在胃癌组织中的表达,并通过对人胃癌细胞系MGC-803转染miR-181a模拟物或抑制剂来考察miR-181a对细胞迁移和增殖的影响。RT-PCR显示,miRNA-181a在胃癌组织中的表达水平显著高于癌旁组织(p<0.05)。伤口愈合实验和Transwell实验显示,转染miR-181a抑制剂或TGF-β受体2(TGFβR2)过表达的pcDNA3.1质粒均可抑制MGC-803细胞的迁移。EdU实验和CCK-8实验显示,转染miR-181a抑制剂或TGFβR2过表达的pcDNA3.1质粒均可抑制MGC-803细胞的增殖。此外,miR-181a抑制剂处理可使TGFβR2蛋白表达明显升高。然而,miR-181a模拟物或抑制剂处理后TGFβR2mRNA水平没有显著变化。总之,本研究表明高表达的miR-181a通过在转录后抑制TGFβR2蛋白表达来促进胃癌细胞的迁移和增殖。miR-181a有望成为胃癌的潜在治疗靶点。     

Enolase1 overexpression regulates the growth of gastric cancer cells and predicts poor survival

Gastric cancer has become the third most common cancer around the world. In patients with gastric cancer, the 5-year survival rate is still low. However, the mechanism underlying gastric cancer remains largely unknown. As a glycolytic enzyme, enolase 1 (ENO1) is widely expressed in most tissues. The functions of ENO1 have been reported in various types of cancer. Here in this study, we identified that ENO1 promoted the growth of gastric cancer cells through diverse mechanisms. Our immunohistochemical, bioinformatic and Western blot data showed that ENO1 was significantly overexpressed in human gastric cancer cell lines and tissues. The survival analysis revealed that ENO1 overexpression predicted poor survival in the patients suffering gastric cancer. Knockdown of ENO1 expression repressed the rate of proliferation and capacity of colony formation in two human gastric cancer cell lines (MGC-803 and MKN-45). In addition, knockdown of the expression of ENO1 led to the arrest of the cell cycle at the G1 phase and promoted the apoptosis of MKN-45 and MGC-803 cells. The further microarray and bioinformatic analysis revealed that ENO1 regulated the expression of diverse genes, many of which are involved in the progress of cancer. Taken together, our data demonstrated that ENO1 was an oncogene-like factor and might serve as a promising target for the treatment of human gastric cancer.     

胃癌中APC基因I1307K突变及蛋白质表达

为探讨肿瘤抑制基因APC结构及表达异常与胃癌发生、发展的关系,采用ARMS PCR检测胃癌中APC基因I1307K突变存在与否,免疫组织化学方法分析胃癌中APC蛋白表达水平。结果表明,在 62例胃癌高发区易感人群血液标本及45例胃癌中未检测到I1307K突变;胃癌（早期、进展期）中APC蛋白表达阳性率显著低于正常黏膜,进展期胃癌中APC蛋白表达阳性率显著低于早期胃癌,淋巴结转移阳性的胃癌中APC蛋白表达阳性率显著低于淋巴结转移阴性者。因此认为I1307K突变可能与国人胃癌发生无明显相关;APC蛋白低表达与胃癌发生、进展及淋巴结转移密切相关。 Abstract:In order to explore the correlation of the abnormalities of tumor suppressor gene APC with the carcinogenesis and progression of gastric cancer.The I1307K mutation of APC gene in gastric cancer was analysed using Amplification Refractory Mutation System PCR(ARMS ,PCR),also the expression of APC protein in gastric cancer of different stages was detected by immunohistochemical method.We found that there wasn't I1307K mutation of APC gene in 62 cases of blood samples of susceptible population in high incidence areas of gastric cancer and 45 cases of gastric cancer tissues.The positive rates of APC protein in gastric cancer (both early and progressive gastric cancer) were significantly lower than that in normal mucosa,the positive rates of APC protein in progressive gastric cancer were significantly lower than that in early gastric cancer,the positive rates of APC protein in gastric cancer with lymph node metastasis were significantly lower than that in gastric cancer without lymph node metastasis.So it was thought that there might be no correlation between the I1307K mutation of APC gene and carcinogenesis of gastric cancer in China,but the decreased expression of APC protein was closely related to the carcinogenesis,progression and lymph node metastasisof gastric cancer.     

Celastrol inhibits gastric cancer growth by induction of apoptosis and autophagy

Recently, the interest in natural products for the treatment of cancer is increasing because they are the pre-screened candidates. In the present study, we demonstrate the therapeutic effect of celastrol, a triterpene extracted from the root bark of Chinese medicine on gastric cancer. The proliferation of AGS and YCC-2 cells were most sensitively decreased in six kinds of gastric cancer cell lines after the treatment with celastrol. Celastrol inhibited the cell migration and increased G1 arrest in cell-cycle populations in both cell lines. The treatment with celastrol significantly induced autophagy and apoptosis and increased the expression of autophagy and apoptosis-related proteins. We also found an increase in phosphorylated AMPK following a decrease in all phosphorylated forms of AKT, mTOR and S6K after the treatment with celastrol. Moreover, gastric tumor burdens were reduced in a dose-dependent manner by celastrol administration in a xenografted mice model. Taken together, celastrol distinctly inhibits the gastric cancer cell proliferation and induces autophagy and apoptosis. [BMB Reports 2014; 47(12): 697-702]     

PCA 和PLS 应用于胃癌亚型分类研究

文章研究了基于微阵列基因表达数据的胃癌亚型分类。微阵列基因表达数据样本少、纬度高、噪声大的特点,使得数据降维成为分类成功的关键。作者将主成分分析(PCA) 和偏最小二乘（PLS）两种降维方法应用于胃癌亚型分类研究,以支持向量机（SVM）、K- 近邻法（KNN）为分类器对两套胃癌数据进行亚型分类。分类效果相比传统的医理诊断略高,最高准确率可达100%。研究结果表明,主成分分析和偏最小二乘方法能够有效地提取分类特征信息,并能在保持较高的分类准确率的前提下大幅度地降低基因表达数据的维数。     

Variation of human mucin gene expression in gastric cancer cell lines and gastric mucous cell primary cultures

Human gastric mucous cells - gastric cancer cell lines mucin gene expression - TNFalpha - RT-PCR immunocytochemistry Little is known on the expression pattern of mucin genes in human gastric cancer cell lines in relation to mucin expression in normal gastric epithelial cells. Thus, the aim of this study was to compare gastric cancer cell lines and non-transformed epithelial cells in their expression of the different mucin genes, in order to use these cells as models for physiological MUC expression in human stomach. Human gastric mucous cell primary cultures which were obtained from surgical specimen by collagenase/pronase treatment and a panel of six human gastric cancer cells were screened for mRNA expression of the mucin genes MUC1, MUC2, MUC5AC, MUC5B, and MUC6. Mucin gene expression was analyzed by semi-quantitative RT-PCR, and by Western blotting and immunocytochemistry. Primary cultured human gastric mucous cells retained the stomach-specific pattern of mRNA expression found in gastric mucosal biopsies (MUC1, MUC5AC, MUC6), whereas any gastric cancer cell line exhibited an aberrant mucin gene expression. Mucin gene expression showed large variations in levels and patterns from cell line to cell line, but MUC2 was aberrantly expressed in all cancer cells. Immunocytochemistry confirmed aberrant MUC2 protein expression in cancer cells. The expression of the secretory mucin genes MUC2 and MUC5AC varied in relation to the length of cultivation of the cancer cell lines. Treatment of the gastric cancer cells with TNFalpha resulted in an enhanced mRNA expression of MUC1, MUC2, and MUC5AC (2-fold increase within 3 hours; p <0.05). In contrast, immunocytochemistry disclosed a decrease in MUC2 and MUC5AC staining intensity. Our results indicate that primary cultured human gastric mucous cells provide a physiological in vitro system for investigations of gastric mucin gene regulation. In gastric cancer cells marked changes in the mucin gene expression pattern are found with coexpression of non-gastric type mucins. Gastric mucin gene expression may be regulated by proinflammatory cytokines which could have implications in gastritis.     

Survivin、Dnmt 和CD44 在胃溃疡及胃癌中表达的差异

胃溃疡(Gastric Ulcer GU)和胃癌(Gastrio Cancer Gc)均是我国乃至全世界人群中的常见病、多发病。近年来,虽然胃溃疡的发病率开始呈下降趋势,但仍属消化系统疾病中最常见的疾病之一,目前已被认为是癌前病变之一。据统计,5%左右的胃溃疡可发生癌变,甚至有统计最高达29.4%的胃癌来自胃溃疡[1]。在世界范围内恶性肿瘤中,胃癌位居第4,病死率位居第2,在我国则居第1位。胃癌发生的分子机制研究表明多基因变异是细胞发生癌变的内因[2]。各种癌基因、抑癌基因和错配修复基因、细胞信号传导通路的异常、细胞周期调控改变及相关产物均对胃癌的发生发展产生影响。如Survivin、DNA甲基化和CD44等均是近年来在胃癌组织中发现的并成为研究热点的基因。通过对Survivin、Dnmt和CD44三种基因在胃溃疡及胃癌中表达的差异的了解,有助于加深对胃癌发生、发展及转移机制的认识,更好的为临床应用中胃溃疡及胃癌的治疗提供理论依据和找到更好的治疗方法。     

Review: Gastric cancer: Basic aspects

Gastric cancer is still one of the most prevalent and deadliest cancers in the world. Although our knowledge about the disease has progressed extraordinarily, this has not been accompanied by our capacity to effectively treat the disease. In the last years, immunotherapy made its way into the cancer field and was responsible for major changes in the treatment success rates for several cancer types. Although gastric cancer was not among the first successful targets of this type of therapy, the relationship between this type of cancer, immunosurveillance and immunotherapy is now being actively researched. In this article, we review the literature of the past year regarding the relationship between gastric cancer, its immune microenvironment and response to immunotherapy. Published data indicate that the immune microenvironment influences the clinical behaviour of gastric cancer, and is correlated with its histologic and molecular subtypes with an emphasis on the microsatellite‐ and EBV‐positive tumour subgroups. Although the literature regarding response to immunotherapy is scarce, there is good evidence that patient stratification for immunotherapy is going to become a reality in gastric cancer.     

幽门螺杆菌感染与胃癌相关性的研究进展

胃癌(gastric cancer)是人类最常见的恶性肿瘤之一,是全球性的医疗难题,其病因尚未完全明确。自20世纪80年代初两位澳大利亚科学家Marshall和Warren首先从胃黏膜中分离出幽门螺杆菌(helicobacter pylori,Hp)至今,Hp与胃癌的关系为人们所关注。经过多年的研究,人们逐渐接受了Hp感染为胃癌发生发展的重要因素,大多数学者认为根除Hp治疗可以降低胃癌发生的风险。然而,近年来随着研究的不断深入,一些研究报道根除Hp治疗并不能预防胃癌的发生发展,也不能降低胃癌的发生率。胃癌的发病机制错综复杂,Hp感染作为单一致病因素如何引起胃癌的发生目前尚未阐述清楚。本文旨在对Hp感染与胃癌相关性的研究进展做一综述。