局部进展期胃癌围手术期治疗中国专家共识(2021版)

Chinese expert consensus on perioperative treatment of locally advanced gastric cancer(2021 version)

局部进展期胃癌(LAGC)的治疗模式,近年来已从单一手术转变为以手术为主的多学科综合治疗。多项研究表明,对多数分期较晚的LAGC,围手术期治疗模式相较于标准根治术联合术后辅助化疗的模式,能进一步改善患者生存。然而,对于精准胃癌术前分期、新辅助和辅助治疗的适用人群以及治疗方案的选择等,迄今仍缺乏统一的标准和规范。在国内外相关研究以及临床实践的基础上,由《中华胃肠外科杂志》牵头,联合中国抗癌协会胃癌专业委员会,组织国内胃癌研究领域的多学科专家,历经多次讨论,制定了本专家共识。旨在提高胃癌内外科医生、特别是基层医院的医生对LAGC多学科综合治疗模式的认识和意识,明确LAGC的术前分期手段,新辅助治疗和辅助治疗的适用人群和推荐方案,以期进一步提高我国胃癌的诊疗水平,改善我国LAGC患者的生存率。本共识证据质量的评价标准和推荐强度采用GRADE分级标准进行判定。

In recent years,the treatment strategy of locally advanced gastric cancer(LAGC)has changed from surgery alone to multidisciplinary comprehensive treatment(MDT)based on surgery.Many evidences have shown that perioperative therapy can improve the survival of most patients with late⁃stage LAGC compared to surgery combined with postoperative adjuvant chemotherapy.However,there is still a lack of standards and guidelines for precise preoperative staging,indications of perioperative neoadjuvant and adjuvant therapy,and regimen selection.Based on relevant literature and clinical practice,Chinese Journal of Gastrointestinal Surgery combined with Gastric Cancer Association,China Anti⁃Cancer Association took the lead and organized multidisciplinary experts to discuss,and finally formulate this expert consensus.This consensus aims to improve surgeons'and physicians'cognition on the MDT of LAGC,especially for doctors in primary hospitals;to clarify the preoperative staging,the indication and regimen selection of perioperative neoadjuvant and adjuvant therapy;so as to improve the diagnosis and treatment level of gastric cancer and the prognosis of LAGC in China.The level of evidence and recommendation of this consensus is determined by the criteria of Grading of Recommendations,Assessment,Development and Evaluations(GRADE).