韦栋木,蒋 旗

胃癌是全球高发的消化系统恶性肿瘤，早期诊断率低、晚期预后差是其高死亡率的主要原因。本文系统综述胃癌的基础特征、流行病学趋势与病理分型，围绕高危人群界定、血清学三联指标（胃蛋白酶原、胃泌素‑17、幽门螺杆菌抗体）、新型胃癌筛查评分系统及传统筛查手段，梳理早期胃癌与胃癌前病变的风险分层策略；同时总结内镜、病理、影像学、人工智能及分子诊断的临床应用进展。当前以“血清学初筛+内镜精查”为核心的模式已成为主流，新型胃癌筛查评分系统在人群分层、成本效益及早癌检出方面优势显著，但仍存在外推性有限、特异度不足等问题。未来应开展多中心前瞻性研究，整合遗传、生活方式、新型标志物与AI技术，构建动态风险预测模型，推动早期胃癌筛查向精准化、规范化、个体化发展。

早期胃癌；胃癌前病变；新型胃癌筛查评分系统；血清学筛查；风险分层；人工智能

[1] Joshi,S.S.and B.D.Badgwell,Current treatment and recent progress in gastric cancer.CA:a cancer journal for clinicians,2021.71(3):p.264-279. [2] 徐文青,王思淇与金雪梅,肠上皮化生的研究进展:机制､临床意义与未来方向.临床与实验病理学杂志,2026.42(01):第93-98+106页. [3] Beck,M.,et al.,Gastric Cancers Missed at Upper Endoscopy in Central Norway 2007 to 2016-A Population-Based Study.Cancers,2021. 13(22):p.5628. [4] Drubay,V.,et al.,Poorly cohesive cells gastric carcinoma including signet-ring cell cancer:Updated review of definition,classification and therapeutic management.World journal of gastrointestinal oncology,2022.14(8):p.1406-1428. [5] Assump O,P.P.,et al.,The diffuse-type gastric cancer epidemiology enigma.BMC gastroenterology,2020.20(1):p.223. [6] Douda,L.,J.Í.Cyrany and I.Tachecí,Early gastric cancer.Vnitrni lekarstvi,2022.68(6):p.371-375. [7] 马江磊等,胃癌临床分期诊断方法的应用进展.上海交通大学学报(医学版),2021.41(06):第821-825页. [8] 刘娟,张政与李鹏,自身免疫性胃炎并发胃早癌的临床特征分析.首都医科大学学报,2025.46(04):第670-675页. [9] Wang,X.,et al.,Emerging trends in early-onset gastric cancer.Chinese medical journal,2024.137(18):p.2146-2156. [10] 杜志成与王亚雷,雷贝拉唑联合内镜下治疗对老年胃早癌患者胃肠功能及免疫功能的影响.中国老年学杂志,2023.43(14):第3384-3387页. [11] Sato,C.,et al.,Clinicopathological features of early gastric cancers arising in Helicobacter pylori uninfected patients.World journal of gastroenterology,2020.26(20):p.2618-2631. [12] Ma,X.,et al.,Clinical outcome of non-curative endoscopic submucosal dissection for early gastric cancer.Journal of gastrointestinal oncology,2024.15(2):p.566-576. [13] Dal Cero,M.,et al.,Clinical Features of Gastric Signet Ring Cell Cancer:Results from a Systematic Review and Meta-Analysis.Cancers, 2023.15(21):p.5191. [14] Liu,J.M.,et al.,Pathological evaluation of endoscopic submucosal dissection for early gastric cancer and precancerous lesion in 411 cases.Beijing da xue xue bao.Yi xue ban=Journal of Peking University.Health sciences,2023.55(2):p.299-307. [15] 仇祎凡等,胃癌筛查方法与模式的现状及展望.海军军医大学学报,2025.46(10):第1336-1343页. [16] 孙树申等,血清PGⅠ､PGⅡ､PGR结合G-17及Hp检测用于早期胃癌和癌前病变的鉴别价值.中国老年学杂志,2024.44(18):第4377-4380页. [17] Rupp,S.,et al.,Diagnostic approach to Helicobacter pylori-related gastric oncogenesis.Annals of gastroenterology,2022.35(4):p.333-344. [18] Zhu,J.,et al.,Progress on screening for gastric cancer.Zhonghua zhong liu za zhi[Chinese journal of oncology],2020.42(7):p.603-608. [19] Huang,R.J.,et al.,Controlling Gastric Cancer in a World of Heterogeneous Risk.Gastroenterology,2023.164(5):p.736-751. [20] Chen,H.and H.Xu,Effect of Gastrin G-17 Combined with Pepsinogen PGI and PGII on the Early Screening of Gastric Cancer in the Department of Gastroenterology.Alternative therapies in health and medicine,2024.30(9):p.141-145. [21] Sun,H.,Helicobacter pylori-related serum indicators:Cutting-edge advances to enhance the efficacy of gastric cancer screening.World journal of gastrointestinal oncology,2025.17(3):p.100739. [22] 程艳萍等,胃癌家族史及血清学指标联合14C呼气试验在中老年人群胃癌筛查中价值.中国公共卫生,2020.36(01):第16-19页. [23] Bordin,D.S.,et al.,Current Helicobacter pylori Diagnostics.Diagnostics(Basel,Switzerland),2021.11(8):p.1458. [24] 江爱军,对比上消化道钡餐造影与螺旋CT诊断胃底贲门癌的临床价值.吉林医学,2016.37(02):第299-301页. [25] Beresniak,A.,et al.,Helicobacter pylori"Test-and-Treat"strategy with urea breath test:A cost-effective strategy for the management of dyspepsia and the prevention of ulcer and gastric cancer in Spain-Results of the Hp-Breath initiative.Helicobacter,2020.25(4):p.e12693. [26] Zhou,Q.,et al.,Application of a novel scoring system for gastric cancer opportunistic screening in hospital visits.BMC gastroenterology, 2022.22(1):p.223. [27] Li,L.,et al.,Clinical applicability of a new scoring system for population-based screening and risk factors of gastric cancer in the Wannan region.BMC gastroenterology,2022.22(1):p.306. [28] Zheng,P.and J.Liu,Cost-Effectiveness Analysis of Hp and New Gastric Cancer Screening Scoring System for Screening and Prevention of Gastric Cancer.Current oncology(Toronto,Ont.),2023.30(1):p.1132-1145. [29] Wang,X.,et al.,The application of new gastric cancer screening score system for gastric cancer screening and risk assessment of gastric precancerous lesions in China.Scandinavian journal of gastroenterology,2023.58(1):p.34-37. [30] Lei,C.,et al.,Artificial intelligence-assisted diagnosis of early gastric cancer:present practice and future prospects.Annals of medicine, 2025.57(1):p.2461679. [31] Conti,C.B.,et al.,Early Gastric Cancer:Update on Prevention,Diagnosis and Treatment.International journal of environmental research and public health,2023.20(3):p.2149. [32] Kitagawa,Y.,et al.,Clinical outcome of the delineation-without-negative-biopsy strategy in magnifying image-enhanced endoscopy for identifying the extent of differentiated-type early gastric cancer.Surgical endoscopy,2022.36(9):p.6576-6585. [33] Park,J.Y.and T.J.Jeon,Diagnostic evaluation of endoscopic ultrasonography with submucosal saline injection for differentiating between T1a and T1b early gastric cancer.World journal of gastroenterology,2022.28(46):p.6564-6572. [34] Ziogas,D.I.,et al.,Endoscopic Ultrasound(EUS)in Gastric Cancer:Current Applications and Future Perspectives.Diseases(Basel, Switzerland),2025.13(8):p.234. [35] de Nucci,G.,et al.,Linear EUS Accuracy in Preoperative Staging of Gastric Cancer:A Retrospective Multicenter Study.Diagnostics (Basel,Switzerland),2023.13(11):p.1842. [36] Ungureanu,B.S.,et al.,Endoscopic Ultrasound vs.Computed Tomography for Gastric Cancer Staging:A Network Meta-Analysis. Diagnostics(Basel,Switzerland),2021.11(1):p.134. [37] 吴宏博等,基于卷积神经网络的人工智能技术在早期胃癌识别中的应用.第三军医大学学报,2021.43(18):第1735-1742页. [38] 陈帅与李响,胃癌临床分期MSCT研究进展.放射学实践,2023.38(09):第1215-1221页. [39] Huang,Y.,et al.,Current research status and hotspots of precancerous lesions of gastric cancer:a bibliometric analysis.Frontiers in oncology,2025.15:p.1571617. [40] 石雅男等,基于人工智能的病理组学在胃癌中的应用进展与挑战.胃肠病学和肝病学杂志,2025.34(12):第1727-1730页. [41] Mousavi,S.E.,et al.,Epidemiology and socioeconomic correlates of gastric cancer in Asia:results from the GLOBOCAN 2020 data and projections from 2020 to 2040.Scientific reports,2025.15(1):p.6529. [42] Matsuoka,T.and M.Yashiro,Novel biomarkers for early detection of gastric cancer.World journal of gastroenterology,2023.29(17):p.2515-2533. [43] 胡非凡,占强与安方梅,单细胞转录组测序技术在胃癌肿瘤微环境重编程研究中的应用进展.南京医科大学学报(自然科学版),2025.45(02):第285-290页. [44] 陈嘉文等,人工智能在胃癌诊断､治疗及预后中的应用与挑战.中国肿瘤外科杂志,2026.18(01):第14-21页. [45] Huang,R.J.,et al.,Controlling Gastric Cancer in a World of Heterogeneous Risk.Gastroenterology(New York,N.Y.1943),2023.164(5):p.736-751.

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