Ruijie Zeng et al.
Abstract
Gastric cancer (GC) is one of the most common malignancies and a prominent cause of cancer mortality worldwide. A distinctive characteristic of GC is its intimate association with the commensal microbial community. Although Helicobacter pylori is widely recognised as an inciting factor of the onset of gastric carcinogenesis, increasing evidence has indicated the substantial involvement of microbes that reside in the gastric mucosa during disease progression. In particular, dysregulation in gastric microbiota could play pivotal roles throughout the whole carcinogenic processes, from the development of precancerous lesions to gastric malignancy. Here, current understanding of the gastric microbiota in GC development is summarised. Potential translational and clinical implications of using gastric microbes for GC diagnosis, prognosis and therapeutics are also evaluated, with further discussion on conceptual haziness and limitations at present. Finally, we highlight that modulating microbes is a novel and promising frontier for the prevention and management of GC, which necessitates future in-depth investigations.
WHAT IS ALREADY KNOWN ON THIS TOPIC
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Helicobacter pylori mainly initiates gastric cancer (GC) in a ‘hit and run’ manner, while gastric microbial dysbiosis other than H. pylori is extensively observed throughout gastric carcinogenesis.
WHAT THIS STUDY ADDS
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Pathobionts (eg, Streptococcus anginosus and Epstein-Barr virus) promote gastric tumourigenesis through interaction with host cells and regulation of tumour microenvironments.
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H. pylori infection induces notable gastric dysbiosis, which can be restored by H. pylori eradication. Probiotics (eg, Lactobacillus and Bifidobacterium) restrain H. pylori and have been widely used in clinical practice.
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Diagnosis and prognosis of GC can be assisted by signatures developed with oral, gastric mucosal and intestinal microbiota, while their efficacy needs to be improved.
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Short-chain fatty acid-producing bacteria can enhance therapeutic efficacy and alleviate treatment-associated adverse events for GC.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
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With advancements in techniques and further delving into the effects and mechanisms of gastric microbe–host interactions, the future is bright for modulating microbes in GC prevention and therapeutics in clinical practice.
