Abstract
Preoperative staging of gastric cancer plays a crucial role in every multimodal treatment protocol. At present, staging intends to be far more than evaluation of the depth of tumor infiltration into the organ wall, that is, T stage, nodular status (N category), and the presence of distant metastases (M stage) according to UICC criteria. In modern surgical oncology it includes more often the evaluation of prognostic factors such as the RAS-protein, p53 tumor suppressor gene, growth factor receptors, cell adhesion molecules, proteolytic factors, and proliferation-associated antigens. Furthermore, evaluation of nodular status is possible by sophisticated computer programs. The conventional staging of gastric cancer using endoscopy and sonography, conventional ultrasonography, computed tomography, and magnetic resonance imaging is discussed. Possible improvements of staging in oncologic centers should include surgical laparoscopy, laparoscopic ultrasonography, and meticulous evaluation of an abdominal lavage including immunohistochemical detection of free tumor cells. The most promising tumor biology-related prognostic factors in gastric cancer are briefly discussed.
Résumé
La détermination préopératoire du stade du cancer gastrique a une place importante d'abord dans chaque bilan et ensuite pour la mise en route du protocole thérapeutique. A présent, il faut considérer le 《staging; comme bien plus que la simple détermination de l'infiltration pariétale de la lésion, i.e. le stade 《T》, de l'état des ganglions, la catégorisation 《N》, et de la présence ou non des métastases à distance, ou le stade 《M》, selon la classification de l'UICC. De plus en plus, il faut inclure l'évaluation des facteurs pronostiques tels que la RAS-protéine, le gène suppreseur p 53, les récepteurs des facteurs de croissance, les molécules d'adhésion cellulaire, des facteurs protéolytiques, et des antigènes en rapport avec la prolifération. Une amélioration de l'évaluation de l;état des ganglions (classification 《N》) est possible grâce aux techniques modernes informatisées. Le 《staging》 conventionnel fait appel à l'endoscopie conventionnelle et l'échoendoscopie, l'échographie conventionnelle, la tomodensitométrie et l'imagerie par résonance magnétique. D'autres progrès sont attendus de la laparoscopie avec échographie per laparoscopie et de l'analyse du liquide de lavage péritonéal y compris la détection des cellules tumorales libres par l'immunohistochimie. Les facteurs pronostiques biologiques les plus promettants sont discutés.
Resumen
La estadificación preoperatoria del cáncer gástrico juega un papel crucial en la aplicación de protocolos de tratamiento multimodal. En los tiempos actuales la estadificación trata de ir más allá de la simple evaluación de la infiltración tumoral de la pared del órgano, o sea el estado T de la condición de los ganglios (categoría N) y de la presencia de metástasis distantes (estado M), en concordancia con los criterios de la UICC. La estadificación incluye, en términos de la oncología quirúrgica moderna, más y más la evaluación de los denominados factores de pronóstico, tales como la proteína RAS, el gen supresor T53, los receptores de fetor de crecimiento, las moléculas de adhesión celular, factores proteolíticos y antígenos asociados a la proliferación. Además, ahora la evaluación del estado ganglionar es posible mediante sofisticados programas de computador. En el presente artículo se discute la estadificación convencional del cáncer gástrico utilizando endoscopia y sonografía, ultrasonido convencional, escanografía computadorizada e imagenología por resonancia magnética. Posibles avances en cuanto a estadificación en centros oncológicos deberán incluir la laparoscopia quirúrgica, la ultrasonografía laparoscópica y la evaluación meticulosa de un lavado peritoneal orientado a la detección immuno-histoquímica de células tumorales libres. También se discuten brevemente los factores de pronóstico de naturaleza de biología tumoral que aparecen más promisorios en la valoración del cáncer gástrico.
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Sendler, A., Dittler, H.J., Feussner, H. et al. Preoperative staging of gastric cancer as precondition for multimodal treatment. World J. Surg. 19, 501–508 (1995). https://doi.org/10.1007/BF00294710
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DOI: https://doi.org/10.1007/BF00294710