早期胃癌及癌前病变的临床、内镜特征与 病理诊断相关研究进展

Research Progress on Clinical Manifestations, Endoscopic Features and Pathological Diagnosis of Early Gastric Cancer and Precancerous Lesions

摘要: 胃癌是消化道最常见的恶性肿瘤之一，早期胃癌(early gastric cancer, EGC)五年生存率可达90%以上，而进展期胃癌不足10%，因此“早发现、早诊断、早治疗”是改善胃癌患者预后的核心。胃癌的发生遵循“正常胃黏膜→慢性炎症→萎缩→肠上皮化生→上皮内瘤变→早期胃癌→进展期胃癌”的Correa级联模式，其中胃上皮内瘤变(gastric intraepithelial neoplasia, GIN)作为明确的癌前病变，与早期胃癌共同构成阻断癌变进程的关键窗口。本文系统综述早期胃癌及癌前病变的临床、内镜特征与病理诊断相关研究的进展，重点分析其临床高危因素、内镜下特点以及病变术前活检与术后病理不一致的危险因素，旨在为早期胃癌及癌前病变的临床精准诊疗提供参考。

Abstract: Gastric cancer is one of the most common types of malignant tumors in the digestive tract. The five-year survival rate for early-stage gastric cancer can reach over 90% while the survival rate for advanced-stage gastric cancer is less than 10%. Therefore, “early detection, early diagnosis and early treatment” are crucial for improving the prognosis of patients with gastric cancer. The pathogenesis of gastric cancer follows the Correa cascade sequence: “normal gastric mucosa → chronic gastritis → gastric atrophy → intestinal metaplasia → intraepithelial neoplasia → early gastric cancer → advanced gastric cancer”. Gastric intraepithelial neoplasia, as a definite precancerous lesion, together with early gastric cancer, constitutes a critical window for blocking canceration progression. This article systematically reviews the research progress in clinical manifestations, endoscopic features and pathological diagnosis of early gastric cancer and precancerous lesions, and focuses on analyzing their clinical risk factors, endoscopic characteristics, and the risk factors associated with discrepancies between preoperative biopsies and postoperative pathology. The aim is to offer insights for the precise clinical diagnosis and treatment of early gastric cancer and its precancerous lesions.