The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2023

The 2023 update of the Chinese Society of Clinical Oncology(CSCO)Clini-cal Guidelines for Gastric Cancer focuses on standardizing cancer diagnosis and treatment in China,reflecting the latest advancements in evidence-based medicine,healthcare resource availability,and precision medicine.These updates address the differences in epidemiological characteristics,clinicopatho-logical features,tumor biology,treatment patterns,and drug selections between Eastern and Western gastric cancer patients.Key revisions include a structured template for imaging diagnosis reports,updated standards for molecular marker testing in pathological diagnosis,and an elevated recommendation for neoadju-vant chemotherapy in stage III gastric cancer.For advanced metastatic gastric cancer,the guidelines introduce new recommendations for immunotherapy,anti-angiogenic therapy and targeted drugs,along with updated management strategies for human epidermal growth factor receptor 2(HER2)-positive and deficient DNA mismatch repair(dMMR)/microsatellite instability-high(MSI-H)patients.Additionally,the guidelines offer detailed screening recommendations for hereditary gastric cancer and an appendix listing drug treatment regimens for various stages of gastric cancer.The 2023 CSCO Clinical Guidelines for Gastric Cancer updates are based on both Chinese and international clinical research and expert consensus to enhance their applicability and relevance in clinical practice,particularly in the heterogeneous healthcare landscape of China,while maintaining a commitment to scientific rigor,impartiality,and timely revisions.

Octopus-like DNA nanostructure coupled with graphene oxide enhanced fluorescence anisotropy for hepatitis B virus DNA detection

Fluorescence Anisotropy(FA)is an effective biochemical detection method based on molecular rotations.Graphene oxide(GO)has been extensively used as an FA amplifier.However,the enhancement of FA by GO alone is limited and the strong scattering of GO will easily make the measurement of FA inaccurate.In order to address these problems,an octopus-like DNA nanostructure(ODN)was designed and coupled with GO to enhance the FA together in this work.By mimicking the multi-clawed structure of the octopus,the ODN can be adsorbed on GO tightly,which not only could improve the sensitivity because of the double FA enhancement abilities of GO and ODN,but also could improve the specificity due to the decrease of the nonspecific interaction in complex samples.Furthermore,ODN could maintain a certain distance between the fluorophore and GO to reduce the fluorescence quenching efficiency of GO,which could improve the accuracy.This method has been applied for the detection of hepatitis B virus DNA(HBV-DNA)in a range of 1-50 nmol/L and the limit of detection(LOD)was 330 pmol/L.In addition,the proposed method has been successfully utilized to detect HBV-DNA in human serum,indicating that this method has a great practical application prospect.

术前应用人工泪液联合rbFGF对白内障合并干眼患者术后眼表功能及泪液中炎症因子水平的影响

目的:探究术前应用人工泪液联合重组牛碱性成纤维细胞生长因子(rbFGF)对白内障合并干眼患者术后眼表功能和泪液中炎症因子水平的影响。方法:选取2019-02/2020-02我院收治的白内障合并干眼患者118例118眼作为研究对象,随机分为对照组和观察组,各59例59眼,对照组术前采用人工泪液治疗,观察组术前采用人工泪液联合rbFGF治疗。比较两组患者治疗前后临床症状评分、眼表功能指标[眼表疾病指数(OSDI)问卷评分、泪膜破裂时间(BUT)、基础泪液分泌试验(SⅠt)和角膜荧光染色评分(FL)]、泪液中炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]及氧化应激指标[丙二醛(MDA)、脂质过氧化物(LPO)、超氧化物歧化酶(SOD)、总抗氧化能力(TAC)]水平,并采用随机行走模型评价两组患者眼表功能及泪液中炎症因子水平。结果:治疗前,两组患者临床症状评分、OSDI、BUT、SⅠt、FL、IL-6、TNF-α、MDA、SOD、LPO、TAC水平均无差异(P>0.05);治疗后30d,两组患者临床症状评分、OSDI、FL、TNF-α、IL-6、MDA、LPO水平明显降低,BUT、SⅠt、SOD、TAC水平明显增加,且观察组患者治疗后的临床症状评分、眼表功能、炎症因子及氧化应激指标改善情况明显优于对照组(P<0.05)。结论:术前采用人工泪液联合rbFGF进行干预可明显改善白内障合并干眼患者术后眼表功能,降低泪液中炎症因子水平,改善干眼症状,为临床上白内障合并干眼的治疗提供参考。

The Chinese Society of Clinical Oncology(CSCO):Clinical guidelines for the diagnosis and treatment of gastric cancer,2021

There exist differences in the epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selections between gastric cancer patients from the Eastern and Western countries.The Chinese Society of Clinical Oncology(CSCO)has organized a panel of senior experts specializing in all sub-specialties of gastric cancer to compile a clinical guideline for the diagnosis and treatment of gastric cancer since 2016 and renews it annually.Taking into account regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted expert consensus judgment on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes in China.The 2021 CSCO Clinical Practice Guidelines for Gastric Cancer covers the diagnosis,treatment,follow-up,and screening of gastric cancer.Based on the 2020 version of the CSCO Chinese Gastric Cancer guidelines,this updated guideline integrates the results ofmajor clinical studies from China and overseas for the past year,focused on the inclusion of research data from the Chinese population for more personalized and clinically relevant recommendations.For the comprehensive treatment of non-metastatic gastric cancer,attentions were paid to neoadjuvant treatment.The value of perioperative chemotherapy is gradually becoming clearer and its recommendation level has been updated.For the comprehensive treatment of metastatic gastric cancer,recommendations for immunotherapy were included,and immune checkpoint inhibitors fromthird-line to the first-line of treatment for different patient groups with detailed notes are provided.

The Chinese Society of Clinical Oncology(CSCO):clinical guidelines for the diagnosis and treatment of gastric cancer

China is one of the countries with the highest incidence of gastric cancer.There are differences in epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selection between gastric cancer patients from the Eastern and Western countries.Non-Chinese guidelines cannot specifically reflect the diagnosis and treatment characteristics for the Chinese gastric cancer patients.The Chinese Society of Clinical Oncology(CSCO)arranged for a panel of senior experts specializing in all sub-specialties of gastric cancer to compile,discuss,and revise the guidelines on the diagnosis and treatment of gastric cancer based on the findings of evidence-based medicine in China and abroad.By referring to the opinions of industry experts,taking into account of regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted experts’consensus judgement on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes.This guideline uses tables and is complemented by explanatory and descriptive notes covering the diagnosis,comprehensive treatment,and follow-up visits for gastric cancer.

Residual circulating tumor DNA after adjuvant chemotherapy effectively predicts recurrence of stage II-III gastric cancer

Background Circulating tumor DNA(ctDNA)is a promising biomarker for predicting relapse in multiple solid cancers.However,the predictive value of ctDNA for disease recurrence remains indefinite in locoregional gastric cancer(GC).Here,we aimed to evaluate the predictive value of ctDNA in this context.Methods From 2016 to 2019,100 patients with stage II/III resectable GC were recruited in this prospective cohort study(NCT02887612).Primary tumors were collected during surgical resection,and plasma samples were collected perioperatively and within 3 months after adjuvant chemotherapy(ACT).Somatic variants were captured via a targeted sequencing panel of 425 cancer-related genes.The plasma was defined as ctDNA-positive only if one or more variants detected in the plasma were presented in at least 2%of the primary tumors.Results Compared with ctDNA-negative patients,patients with positive postoperative ctDNA had moderately higher risk of recurrence[hazard ratio(HR)=2.74,95%confidence interval(CI)=1.37–5.48;P=0.003],while patients with positive post-ACT ctDNA showed remarkably higher risk(HR=14.99,95%CI=3.08-72.96;P<0.001).Multivariate analyses indicated that both postoperative and post-ACT ctDNA positivity were independent predictors of recurrence-free survival(RFS).Moreover,post-ACT ctDNA achieved better predictive performance(sensitivity,77.8%;specificity,90.6%)than both postoperative ctDNA and serial cancer antigen.A comprehensive model incorporating ctDNA for recurrence risk prediction showed a higher C-index(0.78;95%CI=0.71–0.84)than the model without ctDNA(0.71;95%CI=0.64–0.79;P=0.009).Conclusions Residual ctDNA after ACT effectively predicts high recurrence risk in stage II/III GC,and the combination of tissue-based and circulating tumor features could achieve better risk prediction.

Additional gastrectomy in early-stage gastric cancer after non-curative endoscopic resection:a meta-analysis

Background and objective:The role of additional gastrectomy after non-curative endoscopic resection remains uncertain.The present meta-analysis aimed to explore the risk factors for early-stage gastric-cancer patients after non-curative endoscopic resection and evaluate the efficacy of additional gastrectomy.Methods:Relevant studies that reported additional gastrectomy after non-curative endoscopic resection were comprehensively searched in MedLine,Web of Science and EMBASE.We first investigated the risk factors for residual tumor and lymph-node metastasis after non-curative endoscopic resection and then analysed the survival outcome,including 5-year overall survival(OS)and 5-year disease-free survival,of additional gastrectomy.Results:Twenty-one studies comprising 4870 cases were included in the present study.We found that residual tumor was associated with larger tumor size(>3 cm)(odds ratio[OR]=2.81,P<0.001),undifferentiated tumor type(OR=1.78,P=0.011)and positive horizontal margin(OR=9.78,P<0.001).Lymph-node metastasis was associated with larger tumor size(>3 cm)(OR=1.73,P<0.001),elevated tumor type(OR=1.60,P=0.035),deeper tumor invasion(>SM1)(OR=2.68,P<0.001),lymphatic invasion(OR=4.65,P<0.001)and positive vertical margin(OR=2.30,P<0.001).Patients who underwent additional gastrectomy had longer 5-year OS(hazard ratio[HR]=0.34,P<0.001),5-year disease-free survival(HR=0.52,P=0.001)and 5-year disease-specific survival(HR=0.50,P<0.001)than those who did not.Moreover,elderly patients also benefited from additional gastrectomy regarding 5-year OS(HR=0.41,P=0.001).Conclusions:Additional gastrectomy with lymph-node dissectionmight improve the survival of early-stage gastric-cancer patients after non-curative endoscopic resection.However,risk stratification should be performed to avoid excessive treatment.