Chen Jinhu, Ye Qing, Huang Feng
Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou 350014, China.
Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou 350014, China, Email:
Zhonghua Wei Chang Wai Ke Za Zhi. 2019 Feb 25;22(2):196-200.
Based on the four major classic studies of perioperative treatment of locally advanced gastric cancer (LAGC), the North American Intergroup-0116 trial, the European MRC MAGIC trial, the Japan ACTS-GC trial and Korea-China CLASSIC trial, the perioperative therapy of LAGC was divided into three major patterns in the world, namely, postoperative adjuvant chemoradiotherapy in the North America, perioperative chemotherapy in the Europe and postoperative adjuvant chemotherapy in the East Asia. In recent years, scholars around the world have done many researches on the perioperative treatment of gastric cancer. For instance the German FLOT4-AIO trial pushed the perioperative chemotherapy of gastric cancer to a high point, so the NCCN guide changed perioperative chemotherapy to the preferred recommendation, and rewrote the perioperative chemotherapy regimen. The ARTIST trial in Korea showed that the addition of radiotherapy to the adjuvant chemotherapy after D2 radical resection of gastric cancer could not improve the overall survival rate, and further defined adjuvant chemotherapy as the standard treatment in D2 resection of gastric cancer. Asian scholars are actively exploring the application of perioperative chemotherapy in LAGC. For Bulky N cases, neoadjuvant chemotherapy has been recommended as the standard treatment in the Japanese guidelines. The JOCG1509,the RESOLVE and other studies will provide more effective evidence-based recommendations for the best perioperative therapy options of LAGC in Asian countries. At present, it is not clear whether perioperative chemotherapy or postoperative adjuvant chemotherapy is better. In this article, the development course of the three patterns of perioperative therapy of gastric cancer, the research progress in the perioperative period of gastric cancer in recent years, and the changes of guidelines are reviewed in order to provide reference for clinical practice.
基于四项局部进展期胃癌（LAGC）围手术期治疗的主要经典研究，即北美肿瘤协作组0116试验、欧洲医学研究委员会MAGIC试验、日本ACTS-GC试验和韩国-中国CLASSIC试验，LAGC的围手术期治疗在世界范围内分为三种主要模式，即北美模式为术后辅助放化疗、欧洲模式为围手术期化疗、东亚模式为术后辅助化疗。近年来，世界各地的学者对胃癌围手术期治疗进行了诸多研究。例如，德国的FLOT4-AIO试验将胃癌围手术期化疗推向了一个高潮，因此美国国立综合癌症网络（NCCN）指南将围手术期化疗改为首选推荐，并改写了围手术期化疗方案。韩国的ARTIST试验表明，胃癌D2根治性切除术后辅助化疗中加用放疗并不能提高总生存率，并进一步明确辅助化疗为胃癌D2切除的标准治疗。亚洲学者正在积极探索围手术期化疗在LAGC中的应用。对于肿大淋巴结（N）病例，新辅助化疗已被日本指南推荐为标准治疗。日本胃癌协作组1509研究、RESOLVE研究等将为亚洲国家LAGC最佳围手术期治疗方案提供更有效的循证推荐。目前，围手术期化疗和术后辅助化疗哪种更好尚不清楚。本文对胃癌围手术期治疗三种模式的发展历程、近年来胃癌围手术期的研究进展以及指南的变化进行综述，以便为临床实践提供参考。
