[en] INTRODUCTION: The prevalence of diffuse gastric carcinoma (DGC) has progressively increased to equal the incidence of the intestinal type. This tumor poses clinical and therapeutic problems since it does not respond well to the treatments used so far. The extension of the surgery adjusted to the proteomic and genomic molecular subtypes can improve the prognosis of these patients. MATERIAL AND METHODS: Two descriptive and analytical retrospective studies with survival analysis was carried out on a population of 1052 cases of gastric cancer diagnosed at the Cruces University Hospital between 2005-2014. In addition, a proteomic study by liquid chromatography and mass spectrometry of the surgical specimens from 3 cases of DGC and a systematized analysis of the data was obtained. On the other hand, the safety of "95% gastrectomy" technical innovation in the treatment of gastric cancer has been assessed. RESULTS: DGC is more common in women and young people. It is diagnosed in advanced stages and the significant rate of lymph node involvement and the tendency to present peritoneal dissemination stand out. Less than a third of patients survive to 5 years. The spread of the disease and the type of surgical and adjuvant treatment received are factors that have been directly related to overall survival. In the proteomic study, 2,197 proteins were quantified, of the 12,551 gene products found; 75 of them showed significant differences. 45 were up-regulated in tumor tissue and 30 were up-regulated in healthy tissue. A large percentage of the proteins detected belong to the extracellular matrix, which reflects the importance of the proteome on the tumor microenvironment. The molecular functions of the identified proteins, participate in the mesenchymal epithelial transition (TEM), in the cell cycle, and in DNA replication. Comparison of the proteomic profiles of each case analyzed with the previously described DGC proteome map has made it possible to identify the molecular subtype of each of the cases, confirming its coincidence with the clinical picture. DISCUSSION: Recent progress in the description of the GC genome and proteome has resulted in new molecular classifications that must begin to be applied for clinical purposes. Currently, it is feasible to apply the proteomic methodology on tumor samples obtained in the operating room and preserved in tumor banks, with the aim of obtaining a molecular classification of DGC, which helps to make diagnostic and therapeutic decisions. To guide local resections by better definition of the surgical margins; to orient the most appropriate lymphadenectomy; predicting and choosing the best treatment for peritoneal dissemination and assessing the best specific therapeutic targets are some of the consequences of applying this methodology for the oncological treatment of DGC. CONCLUSIONS: The proteomic molecular classification integrated with the clinical pathological data helps to guide the surgery and the adjuvant treatment of CGD, in the context of precision surgery.

[eu] SARRERA: Urdaileko minbizia difusoaren (UMD) prebalentziak gora egin du pixkanaka, heste-motarekin berdindu arte. Arazo kliniko eta terapeutiko handiak sortzen ditu, orain arte erabilitako tratamenduei ez baitie ondo erantzuten. Kirurgiaren hedadura, azpimota molekular proteomiko eta genomikoen arabera doitzeak paziente horien pronostikoa ho- betu dezake. MATERIALA ETA METODOAK: Biziraupen-analisia duten atzera begirako bi azterlan deskribatzaile eta analitiko egin dira Gurutzetako Unibertsitate Ospitalean, 2005- 2014 artean diagnostikatutako 1052 urdaileko minbizi kasuren inguruan. Gainera, UMDaren 3 kasuren pieza kirurgikoen kromatografia likido eta masa-espektrometria bidezko azter- keta proteomikoa eta lortutako datuen analisi sistematizatua egin dira. Bestalde, minbizi gastrikoaren tratamenduan ¿% 95eko gastrektomia¿ berrikuntza teknikoaren segurtasuna baloratu da. EMAITZAK: UMDak proportzio handiagoan eragiten die emakumeei eta gaz- teei. Fase aurreratuetan diagnostikatzen da, eta nabarmentzekoak dira erasan gangliona- rraren tasa altua eta peritoneo-bideko barreiadura izateko joera. Pazienteen herenak bai- no gutxiagok irauten du 5 urte bizirik. Gaixotasunaren barreiatzea eta jasotako tratamendu kirurgiko eta kimioterapiko mota dira biziraupen orokorrarekin zuzenean erlazionatu diren faktoreak. Ikerketa proteomikoan, aurkitutako 12.551 produktu genikoetatik 2.197 proteina kuantifikatu dira; horietatik 75 nabarmendu dira, 45 tumore-ehunean, eta 30 ehun osasunt- suan. Detektatutako proteinen ehuneko handi bat zelulaz kanpoko matrizeari dagokio, eta horrek mikroingurune tumoralaren gaineko proteomaren garrantzia islatzen du. Identifika- tutako proteinen funtzio molekularrak, epitelio mesenkima trantsizioan, ziklo zelularrean eta DNAren erreplikazioan parte hartzea dira. Aztertutako kasu bakoitzaren profil pro- teomikoak aurrez deskribatutako UMDaren proteomaren maparekin konparatuta, kasu bakoitzaren azpimota molekularra identifikatu ahal izan da eta klinikarekin bat datorrela egiaztatu. EZTABAIDA: Urdaileko minbiziaren genoma eta proteomaren deskribapenean egin berri diren aurrerapenek helburu klinikoekin aplikatzen hasi behar direnak sailkapen molekular berriak ekarri dituzte. Gaur egun, posible da metodologia proteomikoa aplikat- zea ebakuntza-gelan lortutako eta tumore-bankuetan gordetako tumore-laginen gainean, UMDaren sailkapen molekularra lortu eta bai diagnostiko zein tratamenduari buruzko era- bakiak hartzen laguntzeko. Kirurgia-marjinak hobeto definituz erauzketa lokala gidatzea; linfadenektomia egokiena orientatzea; peritoneo-barreiatzea iragarri eta tratamendu- rik onena aukeratzea; eta diana terapeutiko espezifiko onenak baloratzea dira, besteak beste, metodologia hori UMDaren tratamendu onkologikorako aplikatzearen abantailak. ONDORIOAK: Datu kliniko patologikoekin integratutako sailkapen molekular proteomi- koa lagungarria da UMDaren kirurgia eta tratamendu gehigarria gidatzeko, doitasunezko kirurgiaren testuinguruan.