Briasoulis Evangelos, Liakakos Theodore, Dova Lefkothea, Fatouros Michael, Tsekeris Pericles, Roukos Dimitrios H, Kappas Angelos M
Department of Medical Oncology (EB), Greece.
Expert Rev Anticancer Ther. 2006 Jun;6(6):931-9. doi: 10.1586/14737140.6.6.931.
Although the very high locoregional recurrence rates reported with limited D0/D1 surgery can be reduced with extended D2 gastrectomy for operable gastric cancer, overall relapse and survival rates remain poor and can only be improved with adequate perioperative adjuvant treatment. However, despite intensive research, no regimen has been established as standard. Meta-analyses have demonstrated a marginal survival benefit with adjuvant chemotherapy. Two recent large randomized trials for operable gastric cancer, the MAGIC trial and the INT-0116 trial, provide evidence that some patients may benefit from perioperative chemotherapy and chemoradiation, respectively. However, while both trials suggest an overall survival benefit with adjuvant treatment, they don't provide the harm-benefit ratio for specific subsets of patients wih different extent of surgery (D1 or D2) and tumor stage (early [T1,2]/advanced [T3,4]). This lack of evidence complicates current therapeutic adjuvant decisions. Estimating the risk of local and distant recurrence (high, moderate or low) after D1 or D2 surgery in various tumor stages and the expected harm-benefit ratio, the authors provide useful information for decisions on adjuvant chemotherapy with or withour radiotherapy in individual patients. Research on newer cytotoxic and targeted agents may improve treatment efficacy. Simultaneously, advances with microarray-based gene-expression profiling signatures may improve individualized treatment decisions. However, the validation and translation of these genomic classifiers as biomarkers into a completed 'bench-to-bedside' cycle for tailoring treatment to individuals is a major challenge and limits inflated expectations.
尽管对于可手术切除的胃癌，扩大的D2胃切除术可降低有限的D0/D1手术所报告的极高的局部区域复发率，但总体复发率和生存率仍然较低，只有通过充分的围手术期辅助治疗才能得到改善。然而，尽管进行了深入研究，但尚未确立标准方案。荟萃分析显示辅助化疗对生存有一定益处。最近两项针对可手术切除胃癌的大型随机试验，即MAGIC试验和INT-0116试验，分别提供了证据表明一些患者可能从围手术期化疗和放化疗中获益。然而，虽然这两项试验都表明辅助治疗可带来总体生存益处，但它们并未提供不同手术范围（D1或D2）和肿瘤分期（早期[T1,2]/晚期[T3,4]）的特定患者亚组的利弊比。这种证据的缺乏使当前的辅助治疗决策变得复杂。通过估计不同肿瘤分期的D1或D2手术后局部和远处复发的风险（高、中或低）以及预期的利弊比，作者为个体患者关于是否进行辅助化疗及是否联合放疗的决策提供了有用信息。对新型细胞毒性药物和靶向药物的研究可能会提高治疗效果。同时，基于微阵列的基因表达谱特征的进展可能会改善个体化治疗决策。然而，将这些基因组分类器作为生物标志物验证并转化为完整的“从 bench 到 bedside”周期以实现个体化治疗是一项重大挑战，并限制了过高的期望。
