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Sawayama et al. J Cancer Metastasis Treat 2018;4:10                 Journal of Cancer
               DOI: 10.20517/2394-4722.2017.79                           Metastasis and Treatment




               Review                                                                        Open Access


               Microenvironment in the pathogenesis of gastric
               cancer metastasis

               Hiroshi Sawayama, Takatsugu Ishimoto, Hideo Baba

               Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556,
               Japan.
               Correspondence to: Prof. Hideo Baba, Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto
               University, 1-1-1 Honjo, Kumamoto 860-8556, Japan. E-mail: hdobaba@kumamoto-u.ac.jp
               How to cite this article: Sawayama H, Ishimoto T, Baba H. Microenvironment in the pathogenesis of gastric cancer metastasis. J Cancer
               Metastasis Treat 2018;4:10. http://dx.doi.org/10.20517/2394-4722.2017.79
               Received: 21 Nov 2017    First Decision: 25 Dec 2017    Revised: 18 Jan 2018    Accepted: 3 Feb 2018    Published: 28 Feb 2018

               Science Editor: Masayuki Watanabe    Copy Editor: Jun-Yao Li    Production Editor: Huan-Liang Wu


               Abstract
               Tumor tissues contain cancer cells, other cellular and non-cellular components. Tumor microenvironments consist of
               cancer cells and various types of stromal cells, cancer associated fibroblasts, bone marrow-derived cells, endothelial cells,
               and hematopoietic cells, mainly tumor-associated macrophages and tumor-infiltrating lymphocytes. Increasing recent
               evidence has demonstrated that alteration of tumor microenvironments is deeply implicated in tumor progression and
               metastasis in gastric cancer (GC) patients. Recent investigations have provided insights into the molecular mechanisms
               of the interaction between tumor cells and tumor microenvironments. Interactions between cancer cells and their
               microenvironment with cytokines and microRNA in extracellular vesicles, such as the exosome, can have a substantial
               impact on tumor characteristics. Alterations in the tumor microenvironment may play a crucial role in facilitating the
               progression of tumor cells and metastasis, as well as the activation of cell signaling pathways, which are associated with
               GC cell proliferation and invasion by genetic or epigenetic alterations. In this review, significant molecular insights into the
               tumor microenvironment, which consist of cancer associated fibroblasts, bone marrow-derived cells, tumor-associated
               macrophages and tumor-infiltrating lymphocytes; the interactions between cancer cells and their microenvironment; and
               the clinical impacts of alterations of GC microenvironments will be discussed.

               Keywords: Tumor microenvironments, cancer associated fibroblasts, bone marrow-derived cells, tumor-associated
               macrophages, tumor-infiltrating lymphocytes



               INTRODUCTION
                                                                                    [1]
               Gastric cancer (GC) is the fourth most commonly diagnosed cancer worldwide . Surgical resection with
               lymph node dissection is the most effective treatment for resectable GC; the standard surgical procedure for

                           © The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
                           International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
                sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
                as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
                and indicate if changes were made.


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