Masuda Yoshio, Fong Kang Ler, Yeo Danson, Yeo Charleen, Chue Koy Min, Araba Said Bani, Lim Chiew Woon, Yeung Baldwin, Lee June, Lin Jinlin, Chia Claramae, Ng Matthew, Ng Kennedy, Samol Jens, Chia Daryl, Teh Jun Liang, Sundar Raghav, Yong Wei-Peng, Tan Hon Lyn, Muro Kei, Lordick Florian, Wainburg Zev, Tan Bo Chuan, Kim Guowei, Suda Koichi, Law Simon, Sano Takeshi, Gurunathan Ramesh, Chiu Philip, Woo Emile, Duong Cuong, Yang Han-Kwang, Long Vo Duy, Kim Hyung Ho, Mahendren Han Alexander, Lee Hyuk Joon, Samarasam Inian, Gotoda Takuji, Liew Reis, Shabbir Asim, Aung Myint Oo, Terashima Masanori, Cheong Edward, So Jimmy, Tan Jeremy
Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Singapore, Singapore.
Ministry of Health Holdings, Singapore, Singapore.
J Gastroenterol. 2025 Jun 13. doi: 10.1007/s00535-025-02266-4.
While the development in multimodal therapies has helped improve treatment outcomes for patients with locally advanced gastric adenocarcinoma (LAGC), there still exist disparities in opinion with an optimal treatment plan. This consensus hopes to provide clinicians with structured guidelines to aid in the decision-making for treatment options for LAGC.
The consensus statement was initiated by establishing a taskforce in collaboration with the Asia Pacific Gastroesophageal Cancer Congress (APGCC) and a multidisciplinary expert panel was selected. Clinical questions on LAGC where perceived variance in practice or opinion may exist were formulated. Studies involving patients with Stage 2 or 3 gastric or Siewert 3 junctional cancers with treatment arms of perioperative chemotherapy, neoadjuvant chemotherapy, adjuvant chemotherapy, immunotherapy and surgery were included. A total of two rounds of voting were performed. Consensus was determined to be reached when a single answer or a combination of either "strongly agree/agree" or "strongly disagree/disagree" responses exceeded 75%.
A total of thirteen clinical questions were developed. They were identified through five main categories: Distal LAGC, Proximal LAGC, Deficient mismatch repair tumors, Chemotherapy and Immunotherapy, and Elderly/Unfit patients. After two rounds of voting by our multidisciplinary expert panel, eleven out of a total thirteen clinical questions had reached consensus. No consensus was reached for two clinical questions.
The APGCC consensus statement aims to guide clinicians in the treatment options for LAGC and Siewert 3 junctional cancer and has clarified some of the roles of perioperative chemotherapy and immunotherapy.
尽管多模式治疗的发展有助于改善局部晚期胃腺癌（LAGC）患者的治疗效果，但对于最佳治疗方案仍存在意见分歧。本共识旨在为临床医生提供结构化指南，以辅助LAGC治疗方案的决策。
通过与亚太地区食管癌大会（APGCC）合作成立一个特别工作组来启动共识声明，并挑选了一个多学科专家小组。针对LAGC在实践或意见上可能存在差异的临床问题进行了拟定。纳入了涉及2期或3期胃癌或Siewert 3型交界性癌患者且治疗方案包括围手术期化疗、新辅助化疗、辅助化疗、免疫治疗和手术的研究。总共进行了两轮投票。当“强烈同意/同意”或“强烈不同意/不同意”的单一答案或组合超过75%时，判定达成共识。
总共提出了13个临床问题。它们通过五个主要类别确定：远端LAGC、近端LAGC、错配修复缺陷肿瘤、化疗和免疫治疗以及老年/身体状况不佳患者。经过我们多学科专家小组的两轮投票，13个临床问题中有11个达成了共识。有两个临床问题未达成共识。
APGCC共识声明旨在指导临床医生对LAGC和Siewert 3型交界性癌的治疗选择，并阐明了围手术期化疗和免疫治疗的一些作用。
