简介：

简介：SinceMurakamidefinedearlygastriccancer(EGC)asa'carcinomalimitedtothegastricmucosaand/orsubmucosaregardlessofthelymphnodestatus',severalauthorshavefocusedonthemostinfluentialhistopathologicalparametersforpredictingthedevelopmentoflymphnodemetastasesbyconsideringthelymphnodestatusasanimportantprognosticfactor.AfewauthorshavealsoconsideredthedepthofinvasionasoneofthekeystoexplainingtheexistenceofsubgroupsofpatientsaffectedbyEGCwithpoorprognoses.Inanycase,EGCisstillconsideredaninitialphaseoftumorprogressionwithgoodprognosis.Theintroductionofmodernendoscopicdeviceshasallowedaprecisediagnosisofearlylesions,whichcanleadtoimproveddefinitionsoftumorsthatcanberadicallytreatedwithendoscopicmucosalresectionorendoscopicsubmucosaldissection(ESD).Giventhewidespreaduseofthesetechniques,theJapaneseGastricCancerAssociation(JGCA)identifiedin2011thestandardcriteriathatshouldexcludethepresenceoflymphnodemetastases.Atthattime,EGCswithnodalinvolvementshouldhavebeenassertedasnolongerfittingthedefinitionofanearlytumor.Someauthorshavealsodemonstratedthatthemorphologicalgrowthpatternofatumor,accordingtoKodama'sclassification,isoneofthemostimportantprognosticfactors,therebysuggestingtheneedtoreportitinhistopathologicaldrafts.NotwithstandingtheacquiredknowledgeregardingtheclinicalbehaviorofEGC,Murakami'sdefinitionisstillbeingused.Thisdefinitionneedstobeupgradedaccordingtothemodernstagingofthediseasesothattheappropriatetreatmentwouldbeselected.

简介：Cancerevadeshostimmunesurveillancebyusingimmunecheckpoints,whichareinhibitorypathwayscrucialformaintainingself-tolerance1.Tumorcellsexpressmultipleinhibitoryligands,andtumor-infiltratinglymphocytes(TIL)expressavarietyofinhibitoryreceptors.InhibitoryreceptorscytotoxicT-lymphocyte-associatedprotein4(CTLA-4)andprogrammeddeath-1