oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2017-16-5-71-86oncotomsk-616Research ArticleОБЗОРЫREVIEWSРАННИЙ РАК ЖЕЛУДКА: СОВРЕМЕННЫЙ ВЗГЛЯД НА ПРОБЛЕМУEARLY GASTRIC CANCER: THE MODERN OPINIONПироговС. С.PirogovS. S.

кандидат медицинских наук, ведущий научный сотрудник эндоскопического отделения

SPIN-код: 7812-5502.

125284, г. Москва, 2-й Боткинский пр., д.3

 

MD, PhD, lead staff research, endoscopy departmen

SPIN-code: 7812-5502

3, 2nd Botkinskу proezd, 125284-Moscow

pirogov@mail.ruСоколовВ. В.SokolovV. V.

доктор медицинских наук, профессор, заведующий эндоскопическим отделением

125284, г. Москва, 2-й Боткинский пр., д.3

Professor, MD, PhD, Head of Endoscopy Department

3, 2nd Botkinskу proezd, 125284-Moscow

profvvs@bk.ruБеляковМ. М.BelyakovM. M.

врач патологоанатомического отделения отдела патоморфологии

125284, г. Москва, 2-й Боткинский пр., д.3

MD, Physician, Pathology Department

3, 2nd Botkinskу proezd, 125284-Moscow

mephistophel_ru@yahoo.comКапринА. Д.KaprinA. D.

академик РАН, доктор медицинских наук, профессор, генеральный директор 

SPIN-код: 1759-8101

125284, г. Москва, 2-й Боткинский пр., д.3

Professor, MD, PhD, Academician of RAS

SPIN-code: 1759-8101.

3, 2nd Botkinskу proezd, 125284-Moscow

kaprin@mail.ruМосковский научно-исследовательский онкологический институт им. П.А. Герцена, филиал ФГБУ «НМИРЦ» МЗ РФРоссияP.A. Herzen Moscow Cancer Research Institute, branch of National Medical Radiology Research CenterRussian Federation2017141120171657186Copyright © Пирогов С.С., Соколов В.В., Беляков М.М., Каприн А.Д., 20172017Пирогов С.С., Соколов В.В., Беляков М.М., Каприн А.Д.Pirogov S.S., Sokolov V.V., Belyakov M.M., Kaprin A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/616

В обзоре рассмотрены основные характеристики раннего рака желудка (РРЖ) в аспекте онкологии, эндоскопии и патоморфологии. Согласно последним концепциям, ранний рак желудка следует рассматривать с позиций эндоскопической резектабельности и прогноза течения заболевания. К данному понятию рекомендуется относить интраэпителиальную неоплазию высокой степени (тяжелую дисплазию) эпителия слизистой оболочки желудка и высокодифференцированную аденокарциному с инвазией в пределах слизистой оболочки (T1a) и/или внутренней части подслизистого слоя (T1b1), а также низкодифференцированную аденокарциному и перстневидноклеточный рак с инвазией в пределах слизистой оболочки (T1a) размерами до 3 см без изъязвления. В соответствии с мнением большинства современных авторов РРЖ должен характеризоваться отсутствием поражения регионарных лимфатических узлов (N0) и отдаленного метастазирования (M0). Ранний рак желудка следует классифицировать по макроскопическим типам с использованием рекомендаций Japanese Society of Gastroenterological Endoscopy или доработанной Парижской классификации поверхностных неоплазий органов желудочно-кишечного тракта по глубине инвазии опухоли и локализации, согласно рекомендациям Japanese Gastric Cancer Association, а также с учетом размеров опухоли. По гистологическому строению все случаи раннего рака желудка должны быть разделены в соответствии с классификацией ВОЗ, 2010 г. или Japanese Gastric Cancer Association. Крайне важным в аспекте риска регионарного метастазирования при РРЖ является оценка наличия опухолевой инвазии лимфатических капилляров и вен подслизистого слоя. В этом же ракурсе наиболее пристального внимания заслуживают и смешанные гистологические формы рака желудка с высоко- и низкодифференцированным компонентом. В обзоре рассмотрены предсказательные критерии оценки риска регионарного метастазирования при РРЖ. Отдельно оценены случаи раннего диффузного наследственного рака желудка, обусловленного наличием аутосомно-доминантной мутации гена CDH1. На основании проведенного обзора литературы даны рекомендации по стратификации рисков и выбора адекватной лечебной тактики у больных ранним раком желудка.

The review presents the clinical and morphological characteristics of early gastric cancer. According to the most recent concepts, early gastric cancer is considered as endoscopically resectable cancer with good prognosis. Currently, early gastric cancer is defined as non-invasive high-grade intraepithelial neoplasia (severe dysplasia) and well-differentiated adenocarcinoma with intramucosal (T1a) and/or minor submucosal (T1b1) invasion as well as poorly cohesive carcinoma, including signet-ring cell carcinoma, confined to the gastric mucosa (≤ 3 cm) without ulceration. Most authors consider that early gastric cancer should be characterized by the absence of regional lymph nodes (N0) and distant metastasis (M0). Early gastric cancer should be classified according to the macroscopic criteria proposed by the Japanese Society of Gastroenterological Endoscopy or the revised version of the Paris classification of superficial neoplastic lesions in the digestive tract as well as according to the World Health Organization classification and the recommendations of the Japanese Gastric Cancer Association. It is important to evaluate lymphovascular invasion in all early gastric cancer cases because of high risk of local metastases. Moreover, cases with mixed-type early gastric cancer (differentiated and undifferentiated components) need to be carefully examined, as they are high-metastatic potential lesions. The review considers predictive criteria for assessing the risk of regional metastasis in early gastric cancer. Cases of hereditary diffuse gastric cancer caused by CDHI gene mutations have been also analyzed. A literature review have allowed us to give recommendations on the risk stratification and the choice of an adequate treatment in patients with early gastric cancer

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The authors declare that there are no conflicts of interest present.