Yanagimoto Yoshitomo, Kurokawa Yukinori, Doki Yuichiro
Department of Surgery Toyonaka Municipal Hospital Osaka Japan.
Department of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka Japan.
Ann Gastroenterol Surg. 2023 Jun 29;7(5):698-708. doi: 10.1002/ags3.12711. eCollection 2023 Sep.
In recent years, important clinical trials for gastric cancer (GC) and esophagogastric junction cancer (EGJC) have been reported, changing the strategies of surgical and perioperative treatment. Although laparoscopic gastrectomy has already been shown to be effective for early-stage cancer, recent evidence from both Asia (JLSSG0901, CLASS-01 and KLASS-02) and Europe (LOGICA and STOMACH trials) has demonstrated that it is useful for advanced GC. Robotic surgery has been rapidly gaining popularity in recent years, and randomized controlled trials are ongoing to evaluate its efficacy. A prospective nationwide multicenter study mapped sites with frequent metastasis and revealed lymphatic flow specific to EGJC, thus establishing the optimal lymph node dissection area and surgical approach based on esophageal involvement. Perioperative chemotherapy, the mainstay of treatment in Europe, also has been established in Asia by the PRODIGY and RESOLVE studies. New clinical trials have been conducted to evaluate the efficacy of combining immunotherapy or molecular-targeted therapy with perioperative chemotherapy or chemoradiotherapy. In this review, we present important recent clinical trials regarding the treatment of GC and EGJC published in 2021 or 2022.
近年来,已有关于胃癌(GC)和食管胃交界癌(EGJC)的重要临床试验报道,这改变了手术及围手术期治疗策略。尽管腹腔镜胃切除术已被证明对早期癌症有效,但来自亚洲(JLSSG0901、CLASS - 01和KLASS - 02)和欧洲(LOGICA和STOMACH试验)的最新证据表明,它对进展期GC也有用。近年来,机器人手术迅速普及,目前正在进行随机对照试验以评估其疗效。一项前瞻性全国多中心研究绘制了转移频繁的部位,并揭示了EGJC特有的淋巴引流,从而根据食管受累情况确定了最佳淋巴结清扫区域和手术入路。围手术期化疗是欧洲治疗的主要手段,在亚洲,PRODIGY和RESOLVE研究也已确立了其地位。已经开展了新的临床试验,以评估免疫治疗或分子靶向治疗与围手术期化疗或放化疗联合应用的疗效。在本综述中,我们介绍了2021年或2022年发表的关于GC和EGJC治疗的近期重要临床试验。