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China is an area with a high incidence of gastric cancer
.
According to statistics in 2015, the incidence and mortality of gastric cancer ranked second, second only to lung cancer
.
The 10-year survival rate of small gastric cancer and micro gastric cancer in the initial stage can reach 100%; the 5-year survival rate after early gastric cancer is 90%; the 5-year survival rate after advanced gastric cancer is less than 30%, especially for advanced gastric cancer.
14% of patients with terminal gastric cancer have a 5-year survival rate of less than 5%, which has completely lost the significance of treatment
.
Early detection, early diagnosis and treatment of gastric cancer is undoubtedly the key to improving the survival rate of gastric cancer
.
According to reports, the rate of early gastric cancer diagnosis in Japan has reached 80%-90%, while the rate of early gastric cancer diagnosis in China is only about 10%.
This is also the reason why the 5-year survival rate of gastric cancer patients in China is far lower than that in Japan
.
Therefore, screening, early detection, early diagnosis, and early treatment among high-risk groups of gastric cancer is an efficient and feasible way to change the severe situation of gastric cancer diagnosis and treatment in China
.
1.
Epidemiology of gastric cancer
Epidemiology of gastric cancer
Gastric cancer is one of the most common gastrointestinal tumors, which seriously threatens human life and health
.
China is a country with a high incidence of gastric cancer.
According to the China Cancer Data Report in 2015, it is estimated that there are 679,000 new cases of gastric cancer and 498,000 deaths each year in China.
Figure 1: Epidemiology of gastric cancer in my country
Figure 1: Epidemiology of gastric cancer in my countryThe prognosis of gastric cancer is closely related to the timing of diagnosis and treatment.
Even if advanced gastric cancer undergoes comprehensive surgical treatment, the 5-year survival rate is still less than 30%, and the quality of life is low, which brings a heavy burden to the family and the country; and Most early gastric cancer can be treated with radical treatment under endoscopy, and the 5-year survival rate exceeds 90%, which greatly saves medical resources
.
However, the current rate of early diagnosis of early gastric cancer in China is less than 10%, which is far lower than that of Japan
.
"China Cancer Prevention and Control Program Outline (2004-2010)" clearly pointed out that early detection, early diagnosis and early treatment of cancer are the main strategies to reduce mortality and improve survival
.
Figure 2: Comparison of the status quo of gastric cancer screening in China and Japan
Figure 2: Comparison of the status quo of gastric cancer screening in China and Japan Figure 2: Comparison of the status quo of gastric cancer screening in China and Japan2.
The importance of early screening for gastric cancer
The importance of early screening for gastric cancer
Usually normal gastric mucosa is infected with Helicobacter pylori, and it will go through a long process to eventually develop into gastric cancer
.
That is, gastric cancer occurs in five parts: superficial gastritis-atrophic gastritis-intestinal metaplasia-intraepithelial neoplasia-gastric cancer
.
Figure 3: Evolution of gastric cancer (Correa model)
Figure 3: Evolution of gastric cancer (Correa model) Figure 3: Evolution of gastric cancer (Correa model)If we control the disease in any state before early gastric cancer, and we intervene and review it regularly, we can prevent the occurrence of gastric cancer
.
However, most of the gastric cancer patients in China are already in the middle and advanced stages when they are diagnosed
.
Three, early gastric cancer screening objects
Three, early gastric cancer screening objectsAccording to my country's national conditions and gastric cancer epidemiological data, and with reference to the "China Consensus on Early Gastric Cancer Screening and Endoscopy Diagnosis and Treatment (2014, Changsha)", the definition of the target population for gastric cancer screening in my country is defined as age ≥ 40 years old and meets the following Any one is recommended as the target population for gastric cancer screening [4]:
People in areas with a high incidence of gastric cancer;
Hp infection;
Previously suffering from precancerous gastric diseases such as chronic atrophic gastritis, gastric ulcer, gastric polyps, postoperative remnant stomach, hypertrophic gastritis, pernicious anemia;
First-degree relatives of gastric cancer patients;
There are other risk factors for gastric cancer (such as high salt intake, salted diet, smoking, heavy drinking, etc.
)
.
Fourth, early gastric cancer screening methods
Fourth, early gastric cancer screening methodsEndoscopy
EndoscopyEndoscopy and endoscopic biopsy are currently the gold standard for the diagnosis of gastric cancer, especially the detection rate of flat and non-ulcer gastric cancer is higher than that of X-ray barium meal and other methods
.
However, the inspection is invasive and not suitable for census
.
Therefore, there is an urgent need for a simple, rapid, reproducible, non-invasive, and convenient dynamic monitoring inspection method as a means of screening for gastric cancer, as well as diagnosis and monitoring of the development of the lesion in the stage of atrophic gastritis
.
Serology
SerologySerum pepsinogen: Decreased PG Ⅰ concentration and/or PG Ⅰ/Ⅱ ratio have a suggestive effect on atrophic gastritis.
Usually, PG Ⅰ concentration ≤70μg/L and PG Ⅰ/Ⅱ≤3.
0 are used to diagnose atrophic gastritis (high gastric cancer).
Risk) threshold, the domestic high-risk area gastric cancer screening adopts PG Ⅰ concentration ≤ 70 μg/L and PG Ⅰ/Ⅱ ≤ 7.
0
.
Gastrin-17 (Gastrin-17): The detection of serum G-17 can reflect the atrophy of gastric antrum mucosa
.
Five, early gastric cancer screening process
Five, early gastric cancer screening processThe 2014 Consensus Opinions on Early Gastric Cancer Screening and Endoscopic Diagnosis and Treatment in China pointed out that it is a more feasible diagnosis strategy to use non-invasive diagnostic methods to screen out high-risk gastric cancer populations, and then to carry out targeted endoscopic examinations.
The screening process is as follows: Figure [4]
.
Figure 4: Early gastric cancer screening process
Figure 4: early gastric cancer screening process Figure 4: early gastric cancer screening processSix, three items of stomach function, "stomach" comes from a healthy
Six, three items of stomach function, "stomach" comes from a healthyThe three tests of serum gastric function only need to draw 2 mL of venous blood.
It is a non-invasive, painless, safe and economical method to assist in the diagnosis of gastric mucosal diseases by measuring PG I, PG II, and G-17 and performing comprehensive analysis.
Gastric disease detection method
.
Serum pepsinogen (PG)
Serum pepsinogen (PG)According to the biochemical and immunochemical properties of pepsinogen, it is divided into pepsinogen I and pepsinogen II
.
Pepsinogen I is secreted by the main cells of the fundus glands and cervical mucous cells; PG I is an indicator of the function of the fundus gland cells (secreting gastric acid)
.
Pepsinogen II is secreted by fundus glands, cardia glands, pyloric glands, and duodenal glands
.
Although a relatively low concentration of PG II, but the secretion of the I area is larger than the PG
.
Figure 5: Serum pepsinogen and gastric disease progression
Figure 5: Serum pepsinogen and gastric disease progression Figure 5: Serum pepsinogen and gastric disease progressionGastrin 17
Gastrin 17Gastrin is mainly secreted by G cells in the gastric antrum mucosa and directly enters the blood circulation
.
More than 95% of the bioactive gastrin in the human body is α-amidated gastrin, of which 80%~90% is gastrin 17 (G-17), and 5%~10% is gastrin 34 (G -34) [5-6]
.
1.
Increased G-17 level
Gastric cancer, atrophic gastritis, senile atrophic gastritis, senile functional dyspepsia, duodenal ulcer
.
Mechanism: Decreased oxyntic glands, low gastric acid in the stomach leads to an increase in serum G17, which is generally greater than 15pmol/L
.
2.
G-17 level decline
Atrophic antral gastritis, multifocal atrophy of the whole stomach
.
Mechanism: The number of G cells decreases, generally less than 1pmol/L
.
Three items of gastric function combined to screen for early gastric cancer
Three items of gastric function combined to screen for early gastric cancerComprehensive studies have found that although the levels of PG in patients with gastric cancer and atrophic gastritis have been reduced to varying degrees, the levels in patients with gastric cancer are even lower, and the G-17 levels of the two are exactly the opposite.
The Common Opinion on Diagnosis and Treatment of Endoscopic Surgery (2014, Changsha) recommends the joint detection of serum G-17, PG I, and PG I/PGII ratios in order to increase the early diagnosis rate of gastric cancer
.
The three serological screenings of gastric function also have obvious advantages in improving the screening effect of gastric cancer and reducing medical costs
.
The use of serological screening strategies for people over 40 years old in China can greatly reduce the risk of gastric cancer.
At the same time, the screening strategy of serum combined with endoscopy has better results
.
7.
Tumor markers related to gastric cancer screening
Tumor markers related to gastric cancer screening
Tumor markers related to gastric cancer screening: CA724, CEA, CA199, CA50
.
In addition to gastric function, which are very good indicators for early gastric cancer screening, gastric cancer-related tumor markers (CA724, CEA, CA199, CA50) are also often used in early gastric cancer screening
.
CA724 (Carbohydrate Antigen 724)
CA724 (Carbohydrate Antigen 724)CA724 was discovered in gastric cancer tissue in 1981
.
CA724 is almost not expressed in normal human tissues, nor is it expressed in many benign proliferative lesions of tissues and organs, but it can be significantly increased in gastrointestinal tumors, breast cancer, ovarian cancer and lung cancer, especially for gastric cancer.
Higher
.
Clinical significance
Clinical significanceThe positive rate of CA724 in gastric cancer is as high as 65%-70%, and those with metastasis are even higher; it can be used as an indicator of follow-up after treatment of gastric cancer, as well as an indicator of recurrence and prognosis; CA724 is related to tumor staging, mucosal involvement, liver metastasis and peritoneum in patients with gastric cancer Infringement related
.
Influencing factors
Influencing factorsCA724 is elevated in a small number of benign and infectious diseases; patients who have received omeprazole, glucocorticoids or non-steroidal anti-inflammatory drugs can see an increase in the level of CA724; CA724 is found to be progressive during taking Ganoderma lucidum spore powder capsules Increased, CA724 returned to normal after deactivation
.
CEA (carcinoembryonic antigen)
CEA (carcinoembryonic antigen)Found in the serum of colon cancer in 1965, it is an acid glycoprotein with the characteristics of human embryonic antigens and a broad-spectrum tumor marker
.
Clinical significance
Clinical significanceMainly seen in colorectal cancer, breast cancer, stomach cancer, lung cancer, pancreatic cancer, etc.
, other malignant tumors also have different degrees of positive rates
.
CEA continuous monitoring can be used for postoperative observation of malignant tumors and prognostic judgment
.
Influencing factors
Influencing factorsRectal polyps, colitis, liver cirrhosis, pneumonia and lung diseases also increased to varying degrees
.
Smokers and the elderly also have elevated CEA
.
CA199 (carbohydrate antigen 199)
CA199 was discovered in 1979 and is currently one of the tumor-associated antigens with the most clinical applications and the most diagnostic value
.
Clinical significance
Clinical significanceMalignant tumors: In gastrointestinal tumors, especially pancreatic cancer, the level of CA199 is significantly increased, which is an important auxiliary diagnostic index
.
CA199 is mainly used for the diagnosis, treatment and prognosis of patients with pancreatic, hepatobiliary and gastric cancer
.
Influencing factors
Influencing factorsElevated levels of CA199 can also be seen in ovarian tumors and bronchial tumors, which can be used for the diagnosis and condition monitoring of ovarian cancer
.
Acute pancreatitis, cholecystitis, cholestatic cholangitis, liver disease, and kidney disease can all cause CA199 levels to rise to varying degrees
.
CA50 (Carbohydrate Antigen 50)
CA50 was discovered in 1983 and is a broad-spectrum tumor marker
.
Clinical significance
Clinical significanceMalignant tumors: CA50 is elevated in malignant tumors such as pancreatic cancer, prostate cancer, stomach cancer, liver cancer, lung cancer, cervical cancer and colorectal cancer, and can be used as an auxiliary diagnostic index
.
It can be used for the prognosis of malignant tumors, radiotherapy and chemotherapy, postoperative observation of curative effect, and early detection of recurrence and metastasis
.
Influencing factors
Influencing factorsCA50 is elevated in a small number of patients with benign liver disease, enteritis, and sclerosing cholangitis
.
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New industry biological ultra-high-speed automatic chemiluminescence immunoassay analyzer MAGLUMI? X8, the single test speed can reach 600T/H, and the expansion can reach 2400T/H; it can be interconnected with the total laboratory automation system (TLA) to build the most suitable laboratory automation solution for customers according to the needs of the site and laboratory
.
Its characteristics are as follows:
Many: 141 registered items, 300 sample positions, 42 reagent positions;
Fast: 600T/H, a single machine is equivalent to an assembly line; the maximum expansion speed can reach 2400T/H;
Good: The failure rate is extremely low, there is no alarm for 100,000 tests, and the intelligent fault self-recovery; the solid-liquid separation of consumables prevents biological risks;
Province: Save space, time, cost, and labor;
Standard: Lower CV value, CV value is about 3%, breaking the industry limit; disposable TIP head, adding samples to prevent cross-contamination; original optical pollution isolation technology in the measurement room; multiple magnetic separation and remixing technology
.
Testing items related to early gastric cancer screening: PGⅠ, PGⅡ, Gastrin-17, CA724, CEA, CA199, CA50
.