进展期胃癌围术期治疗进展

Development of the treatment for advanced gastric cancer in perioperative period

胃癌是当今世界范围内最常见的恶性肿瘤之一,全球大约1/2胃癌病例发生在中国,胃癌居我国恶性肿瘤发病率第3位,死亡率第2位。与日韩早期胃癌诊断率较高的现状不同的是,中国胃癌患者中约90%为进展期或晚期。进展期胃癌的治疗仍以手术为中心,而围术期综合治疗已被证实将为患者带来生存获益。本述评拟探讨进展期胃癌围术期治疗策略。总体而言,目前全球范围内针对进展期胃癌围术期治疗的模式不尽相同。美国以胃癌根治术(D1+)+辅助放疗为主要治疗模式,欧洲以新辅助化疗(ECF/ECX或FLOT方案)+胃癌根治术(D1+)为主要模式,日韩以胃癌根治术(D2)+辅助化疗(S-1或XELOX方案)为主要模式,而随着新辅助放化疗技术的兴起,新辅助放化疗应用于进展期胃癌的治疗模式日益受到胃癌研究者的关注。

Gastric cancer （GC） is one of the most common malignancies worldwide, nearly half of newly diagnosed GC occurs in China, where GC ranks the second for incidence and third for mortality. Unlike Japan and South Korea where majority of GC are early gastric cancer, nearly 90% of GC patients occurred in China are diagnosed as advanced or metastatic disease. Surgery remains the most important component of curative therapy. The treatments for advanced gastric cancer （AGC） include surgery （gastrectomy ＋ lymphadenectomy）, perioperative chemotherapy with or without chemoradiation and other, which are thought to bring survival benefits. This review aims to provide an overview of different treatment modality for AGC. Overview, the treatment priorities for AGC are distinct among the worldwide areas. The major treatment strategy for AGC is curative resection （mainly D1 ~ lymphadenectomy） with adjuvant radiotherapy in US. While in Europe, the major treatment strategy for AGC is perioperative chemotherapy （mainly ECF/ ECX or FLOT regimens） with curative resection （mainly D1 ＋ lymphadenectomy）. Concerning to Asia area, curative resection （mainly D2 lymphadenectomy） with adjuvant chemotherapy （S-1 or XELOX regimen） is the major treatment modality. With the improvement of the neoadjuvant chemoradiotherapy techniques worldwide, the utility of neoadjuvant chemoradiotherapy for AGC were paid more and more attention by oncologists.