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<article article-type="review-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">ssmu</journal-id><journal-title-group><journal-title xml:lang="ru">Бюллетень сибирской медицины</journal-title><trans-title-group xml:lang="en"><trans-title>Bulletin of Siberian Medicine</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1682-0363</issn><issn pub-type="epub">1819-3684</issn><publisher><publisher-name>Siberian State Medical University, the Ministry of Healthcare of the Russian Federation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.20538/1682-0363-2026-2-139-149</article-id><article-id custom-type="elpub" pub-id-type="custom">ssmu-6543</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОРЫ И ЛЕКЦИИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEW AND LECTURES</subject></subj-group></article-categories><title-group><article-title>Молекулярно-генетические параметры прогноза и новые стратегии терапии перитонеального канцероматоза при раке желудка</article-title><trans-title-group xml:lang="en"><trans-title>Molecular and genetic parameters of prognosis and new strategies for the treatment of peritoneal carcinomatosis in gastric cancer</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9429-9813</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Завьялова</surname><given-names>М. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Zavyalova</surname><given-names>M. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Завьялова Марина Викторовна – д-р мед. наук, профессор, вед. науч. сотрудник; зав. кафедрой патологической анатомии </p><p>Россия, 634009, г. Томск, пер. Кооперативный, 5Россия, 634050, г. Томск, Московский тракт, 2 </p></bio><bio xml:lang="en"><p>5 Kooperativny St., 634009 Tomsk, Russian Federation2 Moskovsky trakt, 634050 Tomsk, Russian Federation</p></bio><email xlink:type="simple">zavyalovamv@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0009-0266-6707</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Завьялов</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Zavyalov</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Завьялов Александр Васильевич – студент, лечебный факультет</p><p>Россия, 634050, г. Томск, Московский тракт, 2 </p></bio><bio xml:lang="en"><p>2 Moskovsky trakt, 634050 Tomsk, Russian Federation </p></bio><email xlink:type="simple">zavyalov.av@ssmu.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2133-5064</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Неклюдов</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Neklyudov</surname><given-names>A. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Неклюдов Алексей Андреевич – аспирант, кафедра патологической анатомии</p><p>Россия, 634050, г. Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>2 Moskovsky trakt, 634050 Tomsk, Russian Federation</p></bio><email xlink:type="simple">neklyudov.aa@ssmu.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6082-6136</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Белоусова</surname><given-names>О. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Belousova</surname><given-names>O. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Белоусова Ольга Александровна – аспирант, кафедра патологической анатомии</p><p>Россия, 634050, г. Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>2 Moskovsky trakt, 634050 Tomsk, Russian Federation</p></bio><email xlink:type="simple">belousova.oab@yandex.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8973-8439</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Письменный</surname><given-names>Д. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Pismenny</surname><given-names>D. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Письменный Дмитрий Сергеевич – канд. мед. наук, врач клинической лабораторной диагностики, отделение общей и молекулярной патологии; доцент кафедры патологической анатомии</p><p>Россия, 634009, г. Томск, пер. Кооперативный, 5Россия, 634050, г. Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>5 Kooperativny St., 634009 Tomsk, Russian Federation2 Moskovsky trakt, 634050 Tomsk, Russian Federation</p></bio><email xlink:type="simple">pismenniy.dmitry@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5365-9840</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Миллер</surname><given-names>С. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Miller</surname><given-names>S. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Миллер Сергей Викторович – д-р мед. наук, зав. торакальным отделением</p><p>Россия, 634009, г. Томск, пер. Кооперативный, 5</p></bio><bio xml:lang="en"><p>5 Kooperativny St., 634009 Tomsk, Russian Federation</p></bio><email xlink:type="simple">millersv1309@gmail.com</email><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7633-9620</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Перельмутер</surname><given-names>В. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Perelmuter</surname><given-names>V. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Перельмутер Владимир Михайлович – д-р мед. наук, профессор, гл. науч. сотрудник, отделение общей и молекулярной патологии</p><p>Россия, 634009, г. Томск, пер. Кооперативный, 5Россия, 634050, г. Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>5 Kooperativny St., 634009 Tomsk, Russian Federation2 Moskovsky trakt, 634050 Tomsk, Russian Federation</p></bio><email xlink:type="simple">pvmngs@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Научно-исследовательский институт (НИИ) онкологии, Томский национальный исследовательский  медицинский центр (НИМЦ) Российской академии наук;&#13;
Сибирский государственный медицинский университет (СибГМУ)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Cancer Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences;&#13;
Siberian State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Сибирский государственный медицинский университет (СибГМУ)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Siberian State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Научно-исследовательский институт (НИИ) онкологии, Томский национальный исследовательский медицинский  центр (НИМЦ) Российской академии наук;&#13;
Сибирский государственный медицинский университет (СибГМУ)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Cancer Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences;&#13;
Siberian State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>Научно-исследовательский институт (НИИ) онкологии, Томский национальный исследовательский медицинский  центр (НИМЦ) Российской академии наук</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Cancer Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2026</year></pub-date><pub-date pub-type="epub"><day>23</day><month>07</month><year>2026</year></pub-date><volume>25</volume><issue>2</issue><fpage>139</fpage><lpage>149</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Завьялова М.В., Завьялов А.В., Неклюдов А.А., Белоусова О.А., Письменный Д.С., Миллер С.В., Перельмутер В.М., 2026</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="ru">Завьялова М.В., Завьялов А.В., Неклюдов А.А., Белоусова О.А., Письменный Д.С., Миллер С.В., Перельмутер В.М.</copyright-holder><copyright-holder xml:lang="en">Zavyalova M.V., Zavyalov A.V., Neklyudov A.A., Belousova O.A., Pismenny D.S., Miller S.V., Perelmuter V.M.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://bulletin.ssmu.ru/jour/article/view/6543">https://bulletin.ssmu.ru/jour/article/view/6543</self-uri><abstract><p>Несмотря на достижения современной онкологии, в России в 36% случаев рак желудка выявляется в запущенной стадии, при этом летальность в течение года с момента установления диагноза составляет 39,6%. Одной из частых причин летальных исходов при раке желудка является перитонеальный канцероматоз. Синхронный перитонеальный канцероматоз диагностируется в 18–26% случаев. Метахронный канцероматоз после удаления первичной опухоли наблюдается у 7–39% пациентов через 8,5–26 мес после операции. До настоящего времени не существует эффективных методов прогнозирования риска развития и лечения перитонеального канцероматоза. Опухоли, сопровождающиеся перитонеальным канцероматозом, нередко устойчивы к системной химиотерапии. Выполнение циторедуктивных операций и внутрибрюшинной химиотерапии возможно не для всех пациентов и не всегда является успешным.Обзор посвящен анализу информации, касающейся молекулярно-генетических механизмов развития перитонеального канцероматоза при раке желудка, и содержит оригинальную гипотезу, согласно которой перитонеальный канцероматоз возникает в результате приобретения опухолевыми клетками матрикс-независимости и способности к автономному существованию в асцитической жидкости, не подвергаясь апоптозу (аноикису). С использованием руководства «Предпочтительные элементы отчетности для систематических обзоров и метаанализов» (PRISMA) было выявлено 10 025 научных работ, из которых 228 англоязычных и 323 русскоязычных публикаций соответствовали критериям анализа.В обзор включено 35 статей (в том числе четыре русскоязычные), соответствующих теме настоящего обзора. Предполагается, что выявление ключевых молекул, ассоциированных с матрикс-независимым существованием опухолевых клеток, могло бы послужить основой для разработки технологий прогнозирования перитонеального канцероматоза, а также для разработки новой таргетной терапии метастатического рака желудка.</p></abstract><trans-abstract xml:lang="en"><p>Despite advances in modern oncology, in Russia, 36% of gastric cancers are detected at an advanced stage, with a one-year mortality rate of 39.6%. One of the most common causes of death from gastric cancer is peritoneal carcinomatosis. Synchronous peritoneal carcinomatosis is diagnosed in 18–26% of cases. Metachronous carcinomatosis occurs in 7–39% of patients 8.5–26 months after the primary tumor is removed. To date, there are no effective treatments for peritoneal carcinomatosis. Tumors accompanied by peritoneal carcinomatosis are often resistant to systemic chemotherapy. Cytoreductive surgeries and intraperitoneal chemotherapy are not always possible or successful for all patients.This review focuses on analyzing the molecular and genetic mechanisms of peritoneal carcinomatosis in gastric cancer and presents an original hypothesis suggesting that peritoneal carcinomatosis occurs when tumor cells acquire the ability to autonomously exist in a matrix-independent state in the ascitic fluid without undergoing apoptosis (anoeucsis). Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 10,025 scientific papers were identified, of which 228 English-language and 323 Russian-language publications met the analysis criteria. Twenty-nine articles (including four Russian-language ones) relevant to the topic of this review were included in the review. It is assumed that the identification of key molecules associated with the matrixindependent existence of tumor cells could serve as the basis for the development of technologies for predicting peritoneal carcinomatosis, as well as for the development of new targeted therapy for metastatic gastric cancer.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>перитонеальный канцероматоз</kwd><kwd>рак желудка</kwd><kwd>молекулярно-генетические механизмы</kwd><kwd>матрикс-независимость</kwd><kwd>метастазирование</kwd></kwd-group><kwd-group xml:lang="en"><kwd>peritoneal carcinomatosis</kwd><kwd>stomach cancer</kwd><kwd>molecular and genetic mechanisms</kwd><kwd>matrix independence</kwd><kwd>metastasis</kwd></kwd-group><funding-group><funding-statement xml:lang="ru">Программа «Приоритет 2030».</funding-statement><funding-statement xml:lang="en">Priority 2030 program.</funding-statement></funding-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Состояние онкологической помощи населению России в 2024 году; под ред. 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