Intratumoral heterogeneity in gastric cancer: a new challenge to face

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Abstract
Gastric cancer (GC) is the fifth most common malignancy and the third leading cause of cancer-death worldwide [1], with an overall survival for advanced disease of ∼1 year. Although classically considered as a single disease, GC is highly heterogeneous from the morphological and molecular standpoints. Noteworthy, GC heterogeneity encompasses not only inter-patient variability (intertumoral heterogeneity) but also variations within the same tumor (intratumoral heterogeneity). The latter includes spatial heterogeneity in different tumor areas, and temporal heterogeneity, along progression from primary to recurrent and/or metastatic disease [2]. Despite this feature, for therapeutic purposes, GC patients have been treated with identical chemo and/or radiotherapy regimens and targeted therapies [3, 4], except for the HER2 positive population [5]....

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