性多表达性转化成形 (SPEM):是胃癌发生的隐藏的关键因素,超出了冠状腺级联的范围
Tai Zhang1,2,3, Lanshuo Hu3,4, Beihua Zhang3,4,5
1Peking University Traditional Chinese Medicine Clinical Medical School (Xiyuan), Peking University Health Science Center, Beijing, China.
International journal of surgery (London, England)
|December 5, 2025
概括
性多表达性转化成形 (SPEM) 是胃癌中早期的癌前病变. 由慢性炎症引起的增殖性SPEM,如H. pylori,代表了一个高风险的阶段,与可逆的正规SPEM不同.
科学领域:
- 胃肠道学和瘤学
- 细胞和分子病理学
- 癌症生物学 癌症生物学
背景情况:
- 胃癌是导致死亡的主要原因,传统模型专注于科雷亚的布.
- 新出现的证据突出显示,性多表达性转化成形 (SPEM) 是一种关键的癌前病变.
- SPEM是由表层细胞损失引起的,特征是三叶草因子2表达细胞取代正常的胃系.
研究的目的:
- 审查SPEM在胃癌发生中的病变,分子机制和临床影响.
- 将SPEM定位为比肠道转化症更早,可能更关键的干预点.
- 建议将SPEM评估纳入早期干预的胃癌风险分层.
主要方法:
- 关于SPEM,胃癌发生和Helicobacter pylori感染的现有文献的综述.
- 对支持SPEM驱动路径的形态和分子证据的分析.
- 规范性SPEM和增殖性肠化SPEM的特征和可逆性的比较.
主要成果:
- SPEM表现出二元性:正规的SPEM是修复性的和可逆的,而增殖性肠化的SPEM是一种高风险的,持久的癌前状态.
- 慢性炎症,特别是H. pylori,驱动着正规的SPEM进展到增殖性肠化SPEM,然后是不完整的肠道转化.
- 增殖性肠化SPEM显示持续增殖,肠道基因表达 (CFTR,GPX2,DMBT1,PIGR,VIL1) 和自主细胞周期编程.
结论:
- SPEM是一种关键的,在胃癌发生过程中可能被低估的癌前病变,在肠道转化之前.
- 规范性SPEM为干预提供了一个治疗窗口,而增殖性肠化SPEM则代表了一个不可逆转的阶段.
- 将SPEM评估整合到风险分层协议中,可以更早地拦截胃癌发生.
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