2021年度美国国立综合癌症网络《胃癌临床实践指南》回顾和更新要点解读

Review on the Updates and interpretations on the gastric cancer clinical practice guidelines in oncology from American National Comprehensive Cancer Network in 2021

2021年美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)更新了5版《胃癌临床实践指南》,对病理学检测和生物标志物检测、手术治疗原则、基因检测、系统治疗原则等方面均做出了更新。其中,建议所有标本均需要接受微卫星不稳定和错配修复检测,并进一步细化了二代测序的检测策略,更在后期的版本中提升了其比重。对于可切除胃癌,新版指南增加了内镜治疗的种类、微创外科适应证以及腹腔内温热化疗的应用探索。在系统治疗中则增加了对于人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性晚期胃癌的免疫联合靶向治疗、抗体偶联药物和新的抗PD-1单克隆抗体药物的应用建议。本文结合2021年5版以及2022年1版《胃癌临床实践指南》,对胃癌诊疗的现状和发展进行回顾分析和展望。

Within 2021,the American National Comprehensive Cancer Network(NCCN)has updated five versions of gastric cancer clinical practice guidelines in oncology involving principles of pathologic review and biomarker testing,surgical treatment,genetic risk assessment,and systemic treatment,etc.Among which,universal testing for microsatellite instability and mismatch repair should be performed for all newly diagnosed gastric cancers.Also,strategies for next-generation sequencing are further defined.Which has weighed more by the guidelines.For resectable gastric cancer,the guidelines added the new types of endoscopic treatment,the indications of minimally invasive surgery,and the exploration in the application of hyperthermic intraperitoneal chemotherapy.For systemic therapy,recommendations on the regimens of immunotherapy combined with targeted therapy,antibody-drug conjugates and monoclonal antibodies for human epidermal growth factor receptor 2(HER2)-positive metastatic gastric cancer have been added.The article reviewed the current status of diagnosis and treatment for gastric cancer and future prospects by combining the five updated versions of the gastric cancer clinical practice guidelines in oncology in 2021 and the first updated version in 2022.