{"_":"根除后胃癌残余风险的分层管理。","i":["幽门螺杆菌"]}

摘要(中文译文)

尽管根除幽门螺杆菌已被证实可降低胃癌（GC）发病率，但在成功治疗的个体中仍存在显著的残余风险，其驱动因素为持久的病理改变，称为“致癌记忆”，包括不可逆的黏膜损伤（如肠上皮化生）、残余的促炎及表观遗传“分子瘢痕”以及胃微生物群失调。本视角文章综合现有证据，倡导从单纯聚焦病原体清除转向全面的、风险适配的管理策略。我们提出一种新颖的双维度框架，以多维风险评估为核心，整合OLGA/OLGIM分期、人口学、生活方式及遗传因素，将根除后个体分层为不同的风险类别。该框架进而勾勒出量身定制的监测方案——明确内镜检查频率和先进生物标志物的应用——借助AI辅助内镜和分子检测的技术支持，并详述基于区域胃癌发病率和经济发展的差异化资源配置模式。这一整合性方法为实施精准预防提供了切实可行的路线图，旨在通过超越根除的动态、终身管理体系来减轻持续存在的胃癌风险，并最终降低全球疾病负担。为便于实施，我们提供一款用户可用的风险计算器，将多维评分操作化以适用于队列层面的应用。

Abstract

Despite the established efficacy of eradication in reducing gastric cancer (GC) incidence, a significant residual risk persists in successfully treated individuals, driven by lasting pathological alterations termed "oncogenic memory," including irreversible mucosal damage (e.g., intestinal metaplasia), residual pro-inflammatory and epigenetic "molecular scars," and gastric microbiome dysbiosis. This perspective synthesizes current evidence to advocate for a paradigm shift from a singular focus on pathogen clearance towards a comprehensive, risk-adapted management strategy. We propose a novel, dual-dimensional framework centered on a multidimensional risk assessment that integrates OLGA/OLGIM staging, demographic, lifestyle, and genetic factors to stratify post-eradication individuals into distinct risk categories. The framework subsequently outlines tailored surveillance protocols-specifying endoscopy frequency and advanced biomarker application-leverages technological support from AI-assisted endoscopy and molecular testing, and details differentiated resource allocation models based on regional GC incidence and economic development. This integrated approach provides a practical roadmap for implementing precision prevention, aiming to mitigate the lingering GC risk and ultimately reduce the global disease burden through a dynamic, lifelong management system beyond eradication. To facilitate implementation, we provide a user-ready risk calculator that operationalizes the multidimensional score for cohort-level application.

如何引用

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