Ajani Jaffer, D'Amico Thomas A, Hayman James A, Meropol Neal J, Minsky Bruce
University of Texas M. D. Anderson Cancer Center, USA.
J Natl Compr Canc Netw. 2003 Jan;1(1):28-39. doi: 10.6004/jnccn.2003.0005.
Gastric cancer is rampant in several countries around the world. Its incidence in the West has been on the decline for more than 40 years; however, the location of gastric cancer has shifted proximally in the past 15 years. The reason for this shift is not clear. Diffuse histology is also more common now than intestinal type of histology. Advances have been made in staging procedures such as laparoscopy and endoscopic ultrasonography and in possible functional imaging techniques. The current TNM classification requires an examination of at least 15 lymph nodes; therefore, at least a D1 dissection is recommended. Patients with locoregional gastric carcinoma should also be referred to high-volume treatment centers. Combination chemotherapy and radiotherapy in the adjuvant setting for select group of patients is considered the new standard in the United States. The NCCN Gastric Cancer Guidelines portray uniformity in the systemic approach to cancer in the United States. We look forward to the results of investigations of a number of new chemotherapeutic agents, including antireceptor agents, vaccines, gene therapy, and antiangiogenic agents. The panel anticipates many advances in the treatment of esophageal carcinoma in the future.
胃癌在世界上的几个国家中肆虐。在西方，其发病率在过去40多年里一直在下降；然而，在过去15年中，胃癌的发病部位已向近端转移。这种转移的原因尚不清楚。弥漫性组织学现在也比肠型组织学更为常见。在分期程序（如腹腔镜检查和内镜超声检查）以及可能的功能成像技术方面已经取得了进展。当前的TNM分类要求至少检查15个淋巴结；因此，建议至少进行D1清扫术。局部区域性胃癌患者也应转诊至高容量治疗中心。在美国，针对特定患者群体在辅助治疗中采用联合化疗和放疗被视为新标准。美国国立综合癌症网络（NCCN）胃癌指南体现了美国在癌症系统治疗方法上的一致性。我们期待许多新型化疗药物（包括抗受体药物、疫苗、基因治疗和抗血管生成药物）的研究结果。该小组预计未来食管癌治疗将取得许多进展。
