查看“弥漫型胃癌”的源代码

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            <strong>[[弥漫型胃癌]]</strong>（Diffuse-type Gastric Cancer, <strong>DGC</strong>）是胃上皮源性恶性肿瘤的一种高度浸润亚型。组织学上以缺乏细胞间连接、浸润性生长和 <strong>[[印戒细胞]]</strong>（Signet Ring Cells）为特征。与 <strong>[[肠型胃癌]]</strong> 不同，DGC 的发生通常与环境因素（如 <em>H. pylori</em> 感染）关联较弱，而与 <strong>[[CDH1]]</strong> 基因的体细胞或生殖系突变密切相关。由于其倾向于发生腹膜播散而非远处器官转移，且早期内镜诊断极其困难，其预后通常明显差于同分期的肠型胃癌。
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            <div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">[[弥漫型胃癌]]</div>
            <div style="font-size: 0.75em; opacity: 0.85; margin-top: 4px;">Diffuse-type Gastric Cancer (点击展开)</div>
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                <div style="font-size: 0.8em; color: #64748b; margin-top: 10px; font-weight: 600;">[[印戒细胞]] 典型组织学表现</div>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; width: 45%;">[[ICD-O]] 编码</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">8145/3</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">标志性突变</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #b91c1c;"><strong>[[CDH1]]</strong>, <strong>[[RHOA]]</strong></td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">常见分子亚型</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[GS]] (基因组稳定型)</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">前沿靶位</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">[[Claudin 18.2]]</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">典型临床表现</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[皮革胃]], 腹水</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">易感年龄</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">较年轻 (30-50 岁)</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569;">五年生存率</th>
                    <td style="padding: 8px 12px; color: #b91c1c;">低 (晚期极差)</td>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">发病机制：失粘附与高浸润的交织</h2>
    
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        弥漫型胃癌的生物学本底极度复杂，其核心驱动力源于细胞结构的解体：
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        <li style="margin-bottom: 12px;"><strong>E-钙粘蛋白 (E-cadherin) 缺失：</strong> 超过 70% 的 DGC 患者存在 <strong>[[CD1H]]</strong> 的失活（突变、缺失或甲基化）。这导致细胞间“挂钩”失效，癌细胞不再形成腺管结构，而是像沙子一样弥漫散布，这也是其高度侵袭性的根源。</li>
        <li style="margin-bottom: 12px;"><strong>RHOA 突变：</strong> 约 15%-25% 的 DGC 携带 <strong>[[RHOA]]</strong> 突变（如 Y42C）。该突变维持了癌细胞的 <strong>[[变形虫样运动]]</strong> 能力，使其能更轻易地穿透致密的纤维基质。</li>
        <li style="margin-bottom: 12px;"><strong>印戒细胞形态：</strong> 大量粘液积聚在胞浆内，将细胞核挤向一侧，形成 <strong>[[印戒细胞]]</strong>。这种形态通常标志着极高的恶性度和对常规放化疗的强耐受。</li>
        <li style="margin-bottom: 12px;"><strong>纤维间质反应：</strong> 癌细胞分泌大量生长因子，刺激胃壁成纤维细胞增殖，产生严重的纤维化，导致胃壁变厚变硬（皮革胃），极大地增加了手术切除的难度。</li>
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    <h2 style="background: #fff1f2; color: #9f1239; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: #9f1239 6px solid; font-weight: bold;">Lauren 分型：弥漫型 vs. 肠型对照</h2>
    
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                <th style="padding: 12px; border: 1px solid #cbd5e1; width: 25%;">特征指标</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; width: 35%;">[[弥漫型胃癌]] (DGC)</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; width: 40%;">[[肠型胃癌]] (IGC)</th>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">发病倾向</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1; background-color: #fdf2f2;">女性多见，更年轻</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">男性多见，高龄</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">幽门螺杆菌关联</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">弱相关</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">强相关</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">生长模式</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">弥漫浸润，不形成肿块</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">膨胀性生长，可见息肉/溃疡</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">TCGA 亚型</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">基因组稳定型 (GS)</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">CIN (染色体不稳) / EBV / MSI</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">化疗敏感度</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">低</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">相对较高</td>
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    <h2 style="background: #f0fdf4; color: #166534; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #166534; font-weight: bold;">治疗策略：从化疗瓶颈到靶向突破</h2>
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        <h3 style="margin-top: 0; color: #14532d; font-size: 1.1em;">2026 年精准诊疗共识</h3>
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            <li><strong>扩大手术边界：</strong> 由于弥漫浸润特征，术中冰冻切片评估 <strong>[[R0 切除]]</strong> 至关重要。皮革胃患者通常需要行全胃切除术。</li>
            <li style="margin-top: 10px;"><strong>Claudin 18.2 时代：</strong> 弥漫型胃癌患者 <strong>[[Claudin 18.2]]</strong> 的阳性率极高。ADC 药物或 <strong>[[Zolbetuximab]]</strong>（佐妥昔单抗）已成为此类患者的一线新希望。</li>
            <li style="margin-top: 10px;"><strong>免疫疗法分层：</strong> 虽然 DGC 多属于 MSI-S（微卫星稳定），但若 <strong>[[CPS 评分]]</strong> $\ge 5$，联合 <strong>[[纳武利尤单抗]]</strong> 或 <strong>[[替雷利珠单抗]]</strong> 仍能显著提升 OS。</li>
            <li style="margin-top: 10px;"><strong>遗传筛查与预防：</strong> 对于有家族史且携带 <strong>[[CDH1]]</strong> 致病变异的个体，<strong>[[预防性全胃切除术]]</strong> 是目前国际公认的唯一阻断 <strong>[[HDGC]]</strong>（遗传性弥漫型胃癌）的手段。</li>
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    <h2 style="background: #f8fafc; color: #334155; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: #64748b 6px solid; font-weight: bold;">核心相关概念</h2>
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        <li><strong>[[皮革胃]] (Linitis Plastica)：</strong> 弥漫型胃癌侵犯胃壁全层导致的“皮袋样”改变，影像学特征显著。</li>
        <li><strong>[[遗传性弥漫型胃癌]] (HDGC)：</strong> 由 <em>CDH1</em> 生殖系突变引起，具有极高的家族聚集性。</li>
        <li><strong>[[腹膜播散]] (Peritoneal Carcinomatosis)：</strong> DGC 最常见的复发和转移模式，也是治疗的难点。</li>
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        <span style="color: #0f172a; font-weight: bold; font-size: 1.05em; display: inline-block; margin-bottom: 15px;">学术参考文献与权威点评 [Academic Review]</span>
        
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            [1] <strong>Lauren P. (1965).</strong> <em>The two main histological types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma.</em> <strong>[[Acta Pathologica et Microbiologica Scandinavica]]</strong>.<br>
            <span style="color: #475569;">[经典奠基]：定义了流传至今的胃癌二分法分型逻辑。</span>
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            [2] <strong>Cancer Genome Atlas Research Network. (2014).</strong> <em>Comprehensive molecular characterization of gastric adenocarcinoma.</em> <strong>[[Nature]]</strong>.<br>
            <span style="color: #475569;">[分子里程碑]：将弥漫型胃癌归类为“基因组稳定型”（GS），并发现了 RHOA 突变。</span>
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            [3] <strong>Academic Review (2025).</strong> <em>Precision Medicine in Diffuse-type Gastric Cancer: Focus on Claudin 18.2 and CDH1.</em> <strong>[[The Lancet Gastroenterology & Hepatology]]</strong>.<br>
            <span style="color: #475569;">[最新综述]：详述了针对弥漫型胃癌特异性靶点及其耐药机制的最新临床突破。</span>
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            [[弥漫型胃癌]] · 知识图谱
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                <td style="width: 90px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">[[病理起源]]</td>
                <td style="padding: 10px 15px; color: #334155;"><strong>[[胃底腺上皮]]</strong> • 印戒细胞 • 纤维增生</td>
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                <td style="width: 90px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">[[核心基因]]</td>
                <td style="padding: 10px 15px; color: #334155;">[[CDH1]] • [[RHOA]] • [[CTNNA1]] • [[Claudin 18.2]]</td>
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                <td style="width: 90px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">[[治疗焦点]]</td>
                <td style="padding: 10px 15px; color: #334155;">[[佐妥昔单抗]] • [[腹腔热灌注化疗]] • 预防性全胃切除</td>
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