Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Surg Oncol. 2021 Sep;38:101599. doi: 10.1016/j.suronc.2021.101599. Epub 2021 May 11.
Multidisciplinary management of patients with locally advanced gastric cancer (LAGC) remains unstandardized worldwide. We performed a systemic review to summarize the advancements, regional differences, and current recommended multidisciplinary treatment strategies for LAGC.
Eligible studies were identified through a comprehensive search of PubMed, Web of Science, Cochrane Library databases and Embase. Phase 3 randomized controlled trials which investigated survival of patients with LAGC who underwent gastrectomy with pre-/perioperative, postoperative chemotherapy, or chemoradiotherapy were included.
In total, we identified 11 studies of pre-/perioperative chemotherapy, 38 of postoperative chemotherapy, and 14 of chemoradiotherapy. In Europe and the USA, the current standard of care is perioperative chemotherapy for patients with LAGC using the regimen of 5-FU, folinic acid, oxaliplatin and docetaxel (FLOT). In Eastern Asia, upfront gastrectomy and postoperative chemotherapy is commonly used. The S-1 monotherapy or a regimen of capecitabine and oxaliplatin (CapOx) are used for patients with stage II disease, and the CapOx regimen or the S-1 plus docetaxel regimen are recommended for those with stage III Gastric cancer (GC). The addition of postoperative radiotherapy to peri- or postoperative chemotherapy is currently not recommended. Additionally, clinical trials testing targeted therapy and immunotherapy are increasingly performed worldwide.
Recent clinical trials showed a survival benefit of peri-over postoperative chemotherapy and chemoradiotherapy. As such, this strategy may have a potential as a global standard for patients with LAGC. Outcome of the ongoing clinical trials is expected to establish the global standard of multidisciplinary treatment strategy in patients with LAGC.
局部晚期胃癌（LAGC）的多学科管理在全球尚未标准化。我们进行了系统评价，总结了 LAGC 的进展、地区差异和当前推荐的多学科治疗策略。
通过全面搜索 PubMed、Web of Science、Cochrane 图书馆数据库和 Embase，确定了合格的研究。纳入了研究 LAGC 患者接受胃切除术前/围手术期、术后化疗或放化疗后生存情况的 III 期随机对照试验。
共确定了 11 项术前/围手术期化疗研究、38 项术后化疗研究和 14 项放化疗研究。在欧洲和美国，LAGC 患者的标准治疗方案是使用 5-FU、亚叶酸钙、奥沙利铂和多西紫杉醇（FLOT）的围手术期化疗。在东亚，常用的方法是直接进行胃切除术和术后化疗。S-1 单药或卡培他滨和奥沙利铂（CapOx）方案用于 II 期疾病患者，CapOx 方案或 S-1 加多西紫杉醇方案用于 III 期胃癌（GC）患者。目前不推荐将术后放疗加入围手术期或术后化疗。此外，全球范围内越来越多地开展了靶向治疗和免疫治疗的临床试验。
最近的临床试验表明，围手术期或术后化疗和放化疗有生存获益。因此，这种策略可能有潜力成为 LAGC 患者的全球标准。正在进行的临床试验的结果有望确定 LAGC 患者多学科治疗策略的全球标准。
