Gastric Cancer Epidemiology and Molecular Mechanisms
Summary
Gastric cancer remains a leading cause of cancer mortality worldwide, with marked geographic variation in incidence and outcomes. Rates are highest in East Asia and parts of Eastern Europe, and lower in North America and parts of Africa, reflecting differences in dietary habits, prevalence of Helicobacter pylori infection, and access to screening. Age, sex and socioeconomic status also influence risk, with most cases diagnosed in individuals over 60 and a male predominance. Carcinogenesis proceeds through a multistage sequence from chronic gastritis and atrophic changes to intestinal metaplasia, dysplasia and invasive carcinoma. Genetic and epigenetic alterations accumulate during these phases, affecting tumour suppressor genes (for example, TP53) and oncogenes (for example, HER2, CCND1), as well as pathways controlling cell proliferation, apoptosis and DNA repair. Recent molecular classifications have defined distinct subtypes—such as those characterised by microsatellite instability, Epstein–Barr virus infection or chromosomal instability—each with unique genomic features and therapeutic vulnerabilities. Interactions between tumour cells and the microenvironment, including immune evasion and stromal signalling, further shape disease behaviour and response to treatment. Advances in high-throughput sequencing and functional genomics continue to refine our understanding of the mechanisms driving tumour initiation, progression and resistance, guiding the development of more effective prevention, diagnostic and therapeutic strategies.
Research from Nature Portfolio
Recent studies have revealed that a subset of gastric tumours exhibits a distinctive mutational signature associated with defective homologous recombination repair. Analysis across thousands of cancer genomes demonstrated that 7–12 per cent of gastric cancers carry this signature, suggesting potential benefit from platinum-based chemotherapy or PARP inhibitors in these patients. In parallel, whole-genome sequencing efforts have uncovered diverse patterns of structural variation in gastric tumours. High-level tandem duplications driving oncogene amplification—such as CCND1, ERBB2 and MYC—are recurrent, and a novel hotspot involving a super-enhancer upstream of ZFP36L2 has been identified in around 10 per cent of cases. Moreover, a noncoding mutational signature enriched in tumours harbouring CDH1 alterations correlates with poorer prognosis, providing a genomic basis for refined stratification and targeted intervention.
Gastric Cancer Epidemiology and Molecular Mechanisms publication trend
The graph below shows the total number of articles in gastric cancer epidemiology and molecular mechanisms across all publications each year (not limited to Nature Index journals).
Technical terms
Epidemiology: The study of the distribution and determinants of health-related states or events in populations.
Helicobacter pylori: A bacterium that colonises the gastric mucosa and initiates chronic inflammation leading to precancerous lesions.
Intestinal metaplasia: A premalignant change in which gastric epithelium is replaced by intestinal-type cells.
Homologous recombination: A high-fidelity DNA repair process that corrects double-strand breaks using a sister chromatid as a template.
Mutational signature: A characteristic pattern of DNA alterations reflecting specific mutagenic processes or repair deficiencies.
Tandem duplication: A genomic rearrangement in which a segment of DNA is duplicated and inserted adjacent to the original copy, often amplifying oncogenes.
References
- Gastric Cancer: Epidemiology, Risk Factors, Classification, Genomic Characteristics and Treatment Strategies. International Journal of Molecular Sciences (2020).
- A mutational signature in gastric cancer suggests therapeutic strategies. Nature Communications (2015).
- Molecular classification of gastric cancer: Towards a pathway-driven targeted therapy. Oncotarget (2015).
- Recent Advances in the Diagnosis, Staging, Treatment, and Prognosis of Advanced Gastric Cancer: A Literature Review. Frontiers in Medicine (2021).
- Whole-genome sequencing reveals novel tandem-duplication hotspots and a prognostic mutational signature in gastric cancer. Nature Communications (2019).
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