晚期胃癌综合治疗国内外指南解析

Content analysis of domestic and international guidelines about comprehensive treatment of advanced gastric cancer

我国胃癌病人多为局部侵犯较重或伴远处转移的晚期胃癌,如何提高这部分病例的疗效是临床上必须关注的问题。基于JCOG0110、JCOG1001研究结果,第5版日本胃癌治疗指南不推荐对进展期胃癌进行常规联合脾切除及网膜囊切除术。但这两项研究入组病例的肿瘤进展和恶性程度均偏低,与我国临床病例特点不同,故应慎重借鉴。对难以切除的局部进展期胃癌,国内外指南尚无统一治疗方案。大量研究证明,术前化疗有助于提高R0切除率,延长病人生存时间。动静脉结合给药的术前化疗能够进一步提高化疗效果,改善病人生存。对于伴腹主动脉旁淋巴结或腹膜转移等远处转移的进展期胃癌,可通过化疗、放疗、腹腔化疗等转化治疗手段,有效地延长病人的生存时间。对于我国晚期胃癌病人,应结合病人特点,采用个体化多学科综合治疗模式予以积极治疗,以期改善其生存。

In China, advanced gastric cancer with severe local progression or distant metastasis is more common. How to improve the survival of patients with advanced gastric cancer by multimodality therapies, such as splenectomy, bursectomy and neoadjuvant chemotherapy, and the treatment of advanced gastric cancer accompanied by metastasis to the para-aortic lymph nodes or peritoneal metastasis has been focused on by Chinese scholars. Based on the recently released results of JCOG0110 and 1001 research, the fifth edition of Japanese gastric cancer treatment guidelines currently does not recommend conventional combined splenectomy and bursectomy. Compared with the current situation that the advanced gastric cancer is dominant in China, however, these patients of the two projects showed a low degree of progression and malignancy. Therefore, the clinical significance of these two surgeries should not be completely denied in China. There is no unified treatment plan for the local advanced gastric cancer that has no distant metastasis but is difficult to resect. In fact, a large number of studies have demonstrated that neoadjuvant chemotherapy can improve the resection rate of R0 and prolong the survival time. The author finds out that the preoperative chemotherapy with arterial ＋ vein administration can increase the chemotherapy response rate and improve the survival of patients. There are also many domestic and foreign studies have shown that chemotherapy, radiation therapy, intraperitoneal chemotherapy and other multimodality therapies can effectively prolong the survival time of the patients even with advanced gastric cancer accompanied by metastasis to the para-aortic lymph nodes or peritoneal metastasis. The author believes that it is advisable to actively treat patients with advanced gastric cancer in China through the individualized multidisciplinary comprehensive treatment model so as to improve their survival.