Ajani Jaffer A, D'Amico Thomas A, Bentrem David J, Chao Joseph, Cooke David, Corvera Carlos, Das Prajnan, Enzinger Peter C, Enzler Thomas, Fanta Paul, Farjah Farhood, Gerdes Hans, Gibson Michael K, Hochwald Steven, Hofstetter Wayne L, Ilson David H, Keswani Rajesh N, Kim Sunnie, Kleinberg Lawrence R, Klempner Samuel J, Lacy Jill, Ly Quan P, Matkowskyj Kristina A, McNamara Michael, Mulcahy Mary F, Outlaw Darryl, Park Haeseong, Perry Kyle A, Pimiento Jose, Poultsides George A, Reznik Scott, Roses Robert E, Strong Vivian E, Su Stacey, Wang Hanlin L, Wiesner Georgia, Willett Christopher G, Yakoub Danny, Yoon Harry, McMillian Nicole, Pluchino Lenora A
1The University of Texas MD Anderson Cancer Center.
2Duke Cancer Institute.
J Natl Compr Canc Netw. 2022 Feb;20(2):167-192. doi: 10.6004/jnccn.2022.0008.
Gastric cancer is the third leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improved survival, and enhanced quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing, especially analysis of HER2 status, microsatellite instability (MSI) status, and the expression of programmed death-ligand 1 (PD-L1), has had a significant impact on clinical practice and patient care. Targeted therapies including trastuzumab, nivolumab, and pembrolizumab have produced encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. Palliative management, which may include systemic therapy, chemoradiation, and/or best supportive care, is recommended for all patients with unresectable or metastatic cancer. Multidisciplinary team management is essential for all patients with localized gastric cancer. This selection from the NCCN Guidelines for Gastric Cancer focuses on the management of unresectable locally advanced, recurrent, or metastatic disease.
胃癌是全球癌症相关死亡的第三大主要原因。超过95%的胃癌为腺癌，通常根据解剖位置和组织学类型进行分类。胃癌的预后通常较差，因为它往往在晚期才被诊断出来。对于局部晚期或转移性疾病患者，全身治疗可以提供姑息治疗、提高生存率并改善生活质量。生物标志物检测的实施，尤其是对人表皮生长因子受体2（HER2）状态、微卫星不稳定性（MSI）状态和程序性死亡配体1（PD-L1）表达的分析，对临床实践和患者护理产生了重大影响。包括曲妥珠单抗、纳武利尤单抗和帕博利珠单抗在内的靶向治疗在局部晚期或转移性疾病患者的治疗临床试验中取得了令人鼓舞的结果。对于所有不可切除或转移性癌症患者，建议采用姑息治疗，可能包括全身治疗、放化疗和/或最佳支持治疗。多学科团队管理对所有局限性胃癌患者至关重要。本《美国国立综合癌症网络（NCCN）胃癌临床实践指南》节选重点关注不可切除的局部晚期、复发性或转移性疾病的管理。
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