胃癌癌前病变的诊疗研究进展

Advances in the Diagnosis and Treatment of Gastric Cancer Precancerous Lesions

摘要: 胃癌(gastric cancer, GC)是一种发病率、死亡率较高的恶性肿瘤疾病，近5年中国新发胃癌68.9万例，2020年发病率居恶性肿瘤第3位。据全球数据(Globocan 2020)，GC在全球死亡率居第4位，在中国死亡率居第3位，已成为我国乃至全球一个重要的公共卫生问题。一般而言，胃黏膜在发展为GC之前，需经多年早期胃癌(early gastric cancer, EGC)、胃癌前病变(gastric precancerous lesions, GPL)阶段。目前以根除幽门螺杆菌、COX抑制剂、非甾体类药物、改善胃动力、抑制胆汁反流以及手术等治疗。但治疗后仍会出现较多并发症、敏感性逐渐降低、副反应大等问题；故早期的筛查、识别和治疗可降低胃黏膜癌变的发生及发展，本综述就GC及GPL致病因素、诊疗以及相关机制做一综述。

Abstract: Gastric cancer (GC) is a malignant tumor with high morbidity and mortality. In the past five years, there were 689,000 new cases of gastric cancer in China, and the incidence rate ranked third among malignant tumors in 2020. According to the global data (Globocan 2020), the death rate of GC ranks fourth in the world and third in China, which has become an important public health problem in China and even in the world. In general, the gastric mucosa needs to go through the early gastric cancer (EGC) and gastric precancerous lesions (GPL) stages for many years before developing into GC. At present, Helicobacter pylori eradication, COX inhibitors, non-steroidal drugs, improvement of gastric motility, inhibition of bile reflux and surgery are the treatment. But after treatment, there are still more complications, sensitivity gradually decreased, side effects and other problems. Therefore, early screening, identification and treatment can reduce the occurrence and develop-ment of gastric mucosal cancer. This review reviews the pathogenic factors, diagnosis and treatment, and related mechanisms of GC and GPL.