局部进展期胃癌围手术期治疗的发展历程和研究进展

Historical evolution and research progress of perioperative therapy of locally advanced gastric cancer

基于北美INT-0116、欧洲MAGIC、日本ACTS-GC、韩国-中国CLASSIC四大胃癌围手术期治疗经典研究,局部进展期胃癌(LAGC)围手术期治疗在全球范围内出现三大格局,分别为北美的术后辅助放化疗、欧洲的围手术期化疗及东亚的术后辅助化疗。近年来,世界各国学者在胃癌围手术期治疗方面做了大量的研究,如德国的FLOT4-AIO研究将胃癌围手术期化疗推到了高点,因此,NCCN指南将围手术期化疗更改为首选推荐,并改写了围手术期化疗方案。韩国ARTIST研究显示,在胃癌D2根治术后辅助化疗基础上加用辅助放疗并不能提高总生存率,进一步确定了辅助化疗作为胃癌D2根治术后的标准治疗地位。亚洲学者正积极探索围手术期化疗在LAGC的应用,对于Bulky N病例,新辅助化疗已成为日本指南推荐的标准治疗方案,JOCG 1509、RESOLVE等研究将为亚洲国家LAGC的围手术期最佳治疗选择提供更为有力的循证医学证据,目前围手术期化疗与术后辅助化疗孰优孰劣尚不明确。本文拟从胃癌围手术期治疗三大格局形成的发展历程、近年来全球胃癌围手术期治疗的相关研究进展及指南变更等方面做一综述,以期为临床治疗选择提供参考。

Based on the four major classic studies of perioperative treatment of locally advanced gastric cancer (LAGC), the North American Intergroup-0116 trial, the European MRC MAGIC trial, the Japan ACTS-GC trial and Korea-China CLASSIC trial, the perioperative therapy of LAGC was divided into three major patterns in the world, namely, postoperative adjuvant chemoradiotherapy in the North America, perioperative chemotherapy in the Europe and postoperative adjuvant chemotherapy in the East Asia. In recent years, scholars around the world have done many researches on the perioperative treatment of gastric cancer. For instance the German FLOT4-AIO trial pushed the perioperative chemotherapy of gastric cancer to a high point, so the NCCN guide changed perioperative chemotherapy to the preferred recommendation, and rewrote the perioperative chemotherapy regimen. The ARTIST trial in Korea showed that the addition of radiotherapy to the adjuvant chemotherapy after D2 radical resection of gastric cancer could not improve the overall survival rate, and further defined adjuvant chemotherapy as the standard treatment in D2 resection of gastric cancer. Asian scholars are actively exploring the application of perioperative chemotherapy in LAGC. For Bulky N cases, neoadjuvant chemotherapy has been recommended as the standard treatment in the Japanese guidelines. The JOCG1509, the RESOLVE and other studies will provide more effective evidence-based recommendations for the best perioperative therapy options of LAGC in Asian countries. At present, it is not clear whether perioperative chemotherapy or postoperative adjuvant chemotherapy is better. In this article, the development course of the three patterns of perioperative therapy of gastric cancer, the research progress in the perioperative period of gastric cancer in recent years, and the changes of guidelines are reviewed in order to provide reference for clinical practice.