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2024晚期胃癌诊疗指南更新对比与梳理：CSCO、NCCN和ESMO
Comparison and review of updated guidelines for advanced gastric cancer diagnosis and treatment in 2024: CSCO, NCCN and ESMO
- 中国癌症杂志 2025年35卷第2期 页码：219-227
- 作者机构：
中山大学肿瘤防治中心肿瘤内科，广东 广州 510000
- 作者简介：
[ "蓝 煜（ORCID: 0009-0003-3324-3367），中山大学肿瘤防治中心硕士研究生。" ]
[ "王风华，博士，中山大学肿瘤防治中心肿瘤内科主任医师，教授，博士研究生导师。担任中国临床肿瘤协会胃癌专家委员会副主任委员、中国临床肿瘤协会胰腺癌专家委员会委员、中国抗癌协会肿瘤靶向治疗专委会副主任委员、中国抗癌协会肿瘤支持专业委员会副主任委员、广东省抗癌协会肿瘤靶向治疗专委会主任委员、广东省抗癌协会胰腺癌专业委员会副主任委员。主持国家自然科学基金、广东省基础与应用基础研究基金、吴阶平医学基金会研究课题多项。以第一作者或通信作者身份在SCI收录期刊及中文期刊上发表论文多篇。2023年入选美国斯坦福大学和爱思唯尔数据库发布的全球前2%顶尖科学家榜单。主要擅长肿瘤的内科治疗（化学治疗、靶向治疗），抗癌新药研究，晚期癌症病人的姑息治疗。" ]
- 基金信息：
DOI：10.19401/j.cnki.1007-3639.2025.02.009
中图分类号：收稿：2025-01-07，
修回：2025-02-10，
纸质出版：2025-02-28
- 稿件说明：
移动端阅览
蓝煜, 王风华. 2024晚期胃癌诊疗指南更新对比与梳理：CSCO、NCCN和ESMO[J]. 中国癌症杂志, 2025,35(2):219-227.
Yu LAN, Fenghua WANG. Comparison and review of updated guidelines for advanced gastric cancer diagnosis and treatment in 2024: CSCO, NCCN and ESMO[J]. China Oncology, 2025, 35(2): 219-227.
蓝煜, 王风华. 2024晚期胃癌诊疗指南更新对比与梳理：CSCO、NCCN和ESMO[J]. 中国癌症杂志, 2025,35(2):219-227. DOI： 10.19401/j.cnki.1007-3639.2025.02.009.
Yu LAN, Fenghua WANG. Comparison and review of updated guidelines for advanced gastric cancer diagnosis and treatment in 2024: CSCO, NCCN and ESMO[J]. China Oncology, 2025, 35(2): 219-227. DOI： 10.19401/j.cnki.1007-3639.2025.02.009.
摘要
胃癌是全球范围内高发恶性肿瘤，具有高度侵袭性，总体预后不佳等特点。东西方胃癌人群在流行病学、临床病理学特征、治疗模式及药物选择等方面存在差异。近年来，随着靶向治疗和免疫治疗的快速推进，精准治疗理念的成熟和多学科治疗的推广等，临床研究成果不断更新，胃癌指南每年持续更新，以适应不断变化的诊疗需求。本文就全球范围内三大权威胃癌指南最新版[包括美国国家综合癌症网络（National Comprehensive Cancer Network，NCCN）胃癌临床实践指南2024年V5版（2024年12月发布）、欧洲肿瘤内科学会（European Society for Medical Oncology，ESMO）胃癌在线指南2024版（2024年9月发布）和中国临床肿瘤协会（Chinese Society of Clinical Oncology，CSCO）胃癌诊疗指南（2024年4月发布）]更新内容的异同点进行对比与梳理，聚焦不可手术切除的局部晚期或转移性食管胃结合部和胃腺癌的临床治疗策略，关注基于靶点如人表皮生长因子受体2（human epidermal growth factor receptor 2，HER2）、程序性死亡受体配体1（programmed death-ligand 1，PD-L1）表达、错配修复蛋白（mismatch repair，MMR）状态和新靶点如Claudin 18.2（CLDN18.2）等为导向的抗肿瘤药物的精准实施和全程管理。其中，HER2阳性晚期胃癌进入全线抗HER2治疗时代，抗HER2的抗体药物偶联物（antibody-drug conjugate，ADC）成为一线曲妥珠单抗治疗耐药之后的新选择。除此之外，免疫治疗联合化疗成为晚期胃癌一线治疗新标准，基于MMR状态和PD-L1表达指导的诊疗模式将免疫治疗推向精准化，然而目前PD-L1表达检测在临床推广和执行的过程中仍存在一定困难。2024年发表的三大指南融合了最新的临床研究结果、药物适应证的获批情况和医疗保健系统的实情等内容，尤其是CSCO胃癌指南基于中国自主研发药物的快速发展和针对中国人群研究适应证的成功获批进行了更新。三大指南在靶向治疗、免疫疗法等新疗法的推荐和采用等方面存在差异，本文基于不同指南内容展现出不同的视角与侧重，以丰富临床决策的维度，增强循证医学指南的临床适应性，进而指导临床实践。
Abstract
Gastric cancer is a highly prevalent and aggressive malignancy worldwide
with generally poor prognosis. There are differences in epidemiology
clinicopathological characteristics
treatment modalities
and drug selection for gastric cancer between Eastern and Western populations. Recent advancements in targeted therapy and immunotherapy
the maturation of precision treatment concepts
and the promotion of multidisciplinary therapy have led to continuous updates in clinical research outcomes. Gastric cancer guidelines are annually updated to meet evolving diagnostic and therapeutic needs. This article compared the latest versions of three authoritative global gastric cancer guidelines [National Comprehensive Cancer Network (NCCN) clinical practice guidelines for gastric cancer 2024 version 5
European Society for Medical Oncology (ESMO) online guidelines for gastric cancer 2024
and Chinese Society of Clinical Oncology (CSCO) guidelines for gastric cancer diagnosis and treatment 2024]
focusing on clinical treatment strategies for unresectable locally advanced or metastatic esophagogastric junction/gastric adenocarcinoma
and on the whole-process management and precise implementation guided by targets such as human epidermal growth factor receptor 2 (HER2) expression
programmed cell death ligand 1 (PD-L1) expression
mismatch repair (MMR) status
and novel targets such as Claudin 18.2. Meanwhile
HER2-positive advanced gastric cancer has entered the era of full-line anti-HER2 treatment. Anti-HER2 antibody-drug conjugates (ADCs) has become a new option after first-line trastuzumab resistance. Immunotherapy combined with chemotherapy is regarded as a new standard for the first-line treatment of advanced gastric cancer. The diagnosis and treatment mode based on MMR status and PD-L1 expression promote the precision of immunotherapy. However
the detection of PD-L1 expression has difficulties in clinical promotion and implementation. The three guidelines in 2024 integrate the latest clinical study results
the new indication approval and the updated health care system. In particular
the CSCO gastric cancer guidelines are rewritten based on the rapid development of independently developed drugs in China and the approval of new indications. The three guidelines differ in the recommendation and adoption of targeted therapy and immunotherapy. This article showed different perspectives and focuses based on different guidelines
enriched the dimensions of clinical decision-making
helped the clinical adaptability of evidence-based guidelines to better enlightens clinical practice.
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references
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