Pelc Zuzanna, Sędłak Katarzyna, Leśniewska Magdalena, Mielniczek Katarzyna, Chawrylak Katarzyna, Skórzewska Magdalena, Ciszewski Tomasz, Czechowska Joanna, Kiszczyńska Agata, Wijnhoven Bas P L, Van Sandick Johanna W, Gockel Ines, Gisbertz Suzanne S, Piessen Guillaume, Eveno Clarisse, Bencivenga Maria, De Manzoni Giovanni, Baiocchi Gian Luca, Morgagni Paolo, Rosati Riccardo, Fumagalli Romario Uberto, Davies Andrew, Endo Yutaka, Pawlik Timothy M, Roviello Franco, Bruns Christiane, Polkowski Wojciech P, Rawicz-Pruszyński Karol
Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland.
Department of General Surgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands.
Cancers (Basel). 2024 Apr 28;16(9):1721. doi: 10.3390/cancers16091721.
The incidence of gastric cancer (GC) is expected to increase to 1.77 million cases by 2040. To improve treatment outcomes, GC patients are increasingly treated with neoadjuvant chemotherapy (NAC) prior to curative-intent resection. Although NAC enhances locoregional control and comprehensive patient care, survival rates remain poor, and further investigations should establish outcomes assessment of current clinical pathways. Individually assessed parameters have served as benchmarks for treatment quality in the past decades. The Outcome4Medicine Consensus Conference underscores the inadequacy of isolated metrics, leading to increased recognition and adoption of composite measures. One of the most simple and comprehensive is the "All or None" method, which refers to an approach where a specific set of criteria must be fulfilled for an individual to achieve the overall measure. This narrative review aims to present the rationale for the implementation of a novel composite measure, Textbook Neoadjuvant Outcome (TNO). TNO integrates five objective and well-established components: Treatment Toxicity, Laboratory Tests, Imaging, Time to Surgery, and Nutrition. It represents a desired, multidisciplinary care and hospitalization of GC patients undergoing NAC to identify the treatment- and patient-related data required to establish high-quality oncological care further. A key strength of this narrative review is the clinical feasibility and research background supporting the implementation of the first and novel composite measure representing the "ideal" and holistic care among patients with locally advanced esophago-gastric junction (EGJ) and GC in the preoperative period after NAC. Further analysis will correlate clinical outcomes with the prognostic factors evaluated within the TNO framework.
预计到2040年，胃癌（GC）的发病率将增至177万例。为改善治疗效果，越来越多的GC患者在进行根治性切除术前接受新辅助化疗（NAC）。尽管NAC可增强局部区域控制并提供全面的患者护理，但生存率仍然很低，进一步的研究应确定当前临床路径的疗效评估。在过去几十年中，单独评估的参数一直作为治疗质量的基准。“医学结果共识会议”强调了单一指标的不足之处，促使人们越来越认可和采用综合指标。其中最简单、最全面的方法之一是“全或无”方法，该方法指的是一种个体必须满足特定一组标准才能实现总体指标的方法。本叙述性综述旨在阐述实施一种新型综合指标——教科书式新辅助治疗结果（TNO）的基本原理。TNO整合了五个客观且成熟的组成部分：治疗毒性、实验室检查、影像学检查、手术时间和营养状况。它代表了接受NAC的GC患者所期望的多学科护理和住院治疗情况，以确定进一步建立高质量肿瘤护理所需的治疗相关和患者相关数据。本叙述性综述的一个关键优势在于其临床可行性和研究背景，支持实施首个新型综合指标，该指标代表了局部晚期食管胃交界部（EGJ）和GC患者在NAC术后术前阶段的“理想”和整体护理。进一步的分析将把临床结果与在TNO框架内评估的预后因素相关联。
