侵犯邻近脏器的进展期胃癌的临床诊疗中国专家共识（2024年版）

上海市抗癌协会胃癌专业委员会; 中国人体健康科技促进会胃肠肿瘤专业委员会

doi:10.19401/j.cnki.1007-3639.2024.05.009

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侵犯邻近脏器的进展期胃癌的临床诊疗中国专家共识（2024年版）

指南与共识 | 更新时间：2025-12-31

- 侵犯邻近脏器的进展期胃癌的临床诊疗中国专家共识（2024年版）
- Chinese expert consensus on clinical practice of locally advanced gastric cancer invading adjacent organs (2024 edition)
- 中国癌症杂志 2024年34卷第5期页码：517-526
- 作者机构：
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2024.05.009
  中图分类号： R735.2
- 收稿：2024-02-26，
  
  修回：2024-03-23，
  
  纸质出版：2024-05-30
- 稿件说明：
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上海市抗癌协会胃癌专业委员会, 中国人体健康科技促进会胃肠肿瘤专业委员会. 侵犯邻近脏器的进展期胃癌的临床诊疗中国专家共识（2024年版）[J]. 中国癌症杂志, 2024,34(5):517-526.

Professional Committee on Gastric Cancer of Shanghai Anticancer Association, Professional Committee on Gastrointestinal Cancer of China Association for Promotion of Health Science and Technology. Chinese expert consensus on clinical practice of locally advanced gastric cancer invading adjacent organs (2024 edition)[J]. China Oncology, 2024, 34(5): 517-526.
上海市抗癌协会胃癌专业委员会, 中国人体健康科技促进会胃肠肿瘤专业委员会. 侵犯邻近脏器的进展期胃癌的临床诊疗中国专家共识（2024年版）[J]. 中国癌症杂志, 2024,34(5):517-526. DOI： 10.19401/j.cnki.1007-3639.2024.05.009.

Professional Committee on Gastric Cancer of Shanghai Anticancer Association, Professional Committee on Gastrointestinal Cancer of China Association for Promotion of Health Science and Technology. Chinese expert consensus on clinical practice of locally advanced gastric cancer invading adjacent organs (2024 edition)[J]. China Oncology, 2024, 34(5): 517-526. DOI： 10.19401/j.cnki.1007-3639.2024.05.009.

摘要

胃癌是常见的消化系统恶性肿瘤之一，中国有超过7成的胃癌患者确诊时已进入进展期。对于侵犯邻近脏器的局部进展期胃癌而言，不仅诊断、手术困难，而且预后差，严重威胁着中国民众的健康。为进一步规范侵犯邻近脏器的局部进展期胃癌的临床诊疗，采用循证医学方法，聚焦国内外目前对于进展期胃癌侵犯邻近脏器的诊疗进展，以目前已有较高循证医学证据的临床研究结果为线索，探讨诊断、治疗及疗效评估模式等多个方面，在文献检索的基础上，进行质量等级评价、证据综合，并采用德尔菲问卷调查法，对进展期胃癌侵犯邻近脏器的临床诊疗过程中所共同关注的诊断方法、围手术期治疗、手术治疗及疗效评估等具体问题和热点，通过多学科专家会议讨论、问卷调查等形式，经过4次对10多个不同地区、24家医院共计37名专家意见的调查汇总、归纳、梳理和总结，依托上海市抗癌协会胃癌专业委员会和中国人体健康科技促进会胃肠肿瘤专业委员会，形成了《侵犯邻近脏器的进展期胃癌的临床诊疗中国专家共识（2024年版）》，以期为侵犯邻近脏器的进展期胃癌的基础和临床研究探索提供帮助，并为一线医务人员临床实践等提供证据借鉴和规范依据，进而为后续的相关行业指南制定奠定基础。

Abstract

Gastric cancer is one of the most common malignant tumors

and over 70% of patients were diagnosed as advanced stage at the first visit in our country. For patients with locally advanced gastric cancer invading adjacent organs

the diagnosis and surgical treatment are quite difficult

and prognosis is poor. To further standardize the clinical research practice of locally advanced gastric cancer invading adjacent organs

this consensus was guided by evidence-based methodology

focusing on the progress of diagnosis and treatment in locally advanced gastric cancer invading adjacent organs

and the clinical studies with high level of evidence but not approved at present

and exploring the new modes of diagnosis

efficacy evaluation and other aspects. On the basis of literature retrieval

quality evaluation and evidence summary were carried out

and specific issues and hot topics such as the methods of diagnosis

peri-operative treatment

surgical treatment and other common concerns in the clinical application were discussed and investigated through multidisciplinary expert meetings

Delphi methods and other forms. The “Chinese expert consensus on clinical practice of locally advanced gastric cancer invading adjacent organs (2024 edition)” was completed by the investigation and summarization of the opinions of 35 experts from more than 10 different regions and 30 hospitals for 4 times

relying on Professional Committee on Gastric Cancer of Shanghai Anticancer Association

Professional Committee on Gastrointestinal Cancer of China Association for Promotion of Health Science and Technology

with a view to providing evidence reference and normative basis for frontline medical personnel in future clinical practice of locally advanced gastric cancer treatment

and laying a foundation for subsequent development of relevant industry guidelines.

关键词

Keywords

references

SUNG H , FERLAY J , SIEGEL R L , et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J ] . CA Cancer J Clin , 2021 , 71 ( 3 ): 209 - 249 .

ZHENG R , ZHANG S W , ZENG H , et al. Cancer incidence and mortality in China, 2016 [J ] . J Natl Cancer Cent , 2022 , 2 ( 1 ): 1 - 9 .

薛驰 , 高鹏 , 朱志 , 等 . 免疫治疗在胃癌的围手术期及转化治疗中的应用和挑战 [J ] . 中国癌症杂志 , 2024 , 34 ( 3 ): 259 - 267 . DOI: 10.19401/j.cnki.1007-3639.2024.03.003 http://doi.org/10.19401/j.cnki.1007-3639.2024.03.003

XUE C , GAO P , ZHU Z , et al. Application and challenge of immunotherapy in perioperative therapy of gastric cancer [J ] . China Oncol , 2024 , 34 ( 3 ): 259 - 267 .

YANG Y , WANG X Y , DUAN C , et al. Clinicopathological characteristics and its association with digestive system tumors of 1 111 patients with Schistosomiasis japonica [J ] . Sci Rep , 2023 , 13 ( 1 ): 15115.

OKABE H , AOYAMA H , MIYAHARA Y , et al. Dorsal approach for advanced gastric cancer invading the transverse mesocolon [J ] . Ann Gastroenterol Surg , 2023 , 7 ( 4 ): 678 - 683 . DOI: 10.1002/ags3.12654 http://doi.org/10.1002/ags3.12654

AN W X , BAO L J , WANG C Y , et al. Analysis of related risk factors and prognostic factors of gastric cancer with liver metastasis: a SEER and external validation based study [J ] . Int J Gen Med , 2023 , 16 : 5969 - 5978 . DOI: 10.2147/IJGM.S434952 http://doi.org/10.2147/IJGM.S434952

DING P A , YANG P G , TIAN Y , et al. The clinical value of further accurate staging of PT2 gastric cancer based on the depth of invasion [J ] . Chin J Oncol , 2021 , 43 ( 11 ): 1197 - 1202 .

FANG C , WANG W , DENG J Y , et al. Proposal and validation of a modified staging system to improve the prognosis predictive performance of the 8th AJCC/UICC pTNM staging system for gastric adenocarcinoma: a multicenter study with external validation [J ] . Cancer Commun , 2018 , 38 ( 1 ): 67.

CHEN A H , CHAN W H , LEE Y H , et al. Routine chest CT for staging of gastric cancer [J ] . Br J Surg , 2019 , 106 ( 9 ): 1197 - 1203 . DOI: 10.1002/bjs.11186 http://doi.org/10.1002/bjs.11186

BAI L G , LIU W M , DI S T , et al. Clinical study of CT enhanced scan in preoperative TNM staging of advanced gastric cancer and the effect of misdiagnosis rate [J ] . Panminerva Med , 2023 , 65 ( 2 ): 259 - 260 .

闫文锋 , 孙培春 , 吴刚 , 等 . 3D-CT模拟影像描述胃周动脉变异对腹腔镜全胃切除术的指导作用 [J ] . 中华胃肠外科杂志 , 2021 , 24 ( 2 ): 173 - 178 .

YAN W F , SUN P C , WU G , et al. Application of 3D-CT simulation image in the description of gastric artery variation to guide laparoscopic total gastrectomy [J ] . Chin J Gastrointest Surg , 2021 , 24 ( 2 ): 173 - 178 .

GAI Q , LI X , LI N , et al. Clinical significance of multi-slice spiral CT, MRI combined with gastric contrast-enhanced ultrasonography in the diagnosis of T staging of gastric cancer [J ] . Clin Transl Oncol , 2021 , 23 ( 10 ): 2036 - 2045 . DOI: 10.1007/s12094-021-02606-9 http://doi.org/10.1007/s12094-021-02606-9

TATSUBAYASHI T , TANIZAWA Y , MIKI Y , et al. Treatment outcomes of hepatectomy for liver metastases of gastric cancer diagnosed using contrast-enhanced magnetic resonance imaging [J ] . Gastric Cancer , 2017 , 20 ( 2 ): 387 - 393 . DOI: 10.1007/s10120-016-0611-7 http://doi.org/10.1007/s10120-016-0611-7

PARK J Y , JEON T J . Diagnostic evaluation of endoscopic ultrasonography with submucosal saline injection for differentiating between T1a and T1b early gastric cancer [J ] . World J Gastroenterol , 2022 , 28 ( 46 ): 6564 - 6572 .

SHITARA K , FLEITAS T , KAWAKAMI H , et al. Pan-Asian adapted ESMO clinical practice guidelines for the diagnosis, treatment and follow-up of patients with gastric cancer [J ] . ESMO Open , 2024 , 9 ( 2 ): 102226 .

张维汉 , 胡建昆 . 胃癌腹膜转移诊治现状 [J ] . 中华胃肠外科杂志 , 2021 , 24 ( 3 ): 204 - 207 .

ZHANG W H , HU J K . Current status of diagnosis and treatment of gastric cancer peritoneal metastasis [J ] . Chin J Gastrointest Surg , 2021 , 24 ( 3 ): 204 - 207 .

NOMA T , TAKAHASHI T , MIYAZAKI Y , et al. Multi-look staging laparoscopy and conversion surgery for gastric cancer with peritoneal metastases [J ] . Gan To Kagaku Ryoho , 2019 , 46 ( 1 ): 184 - 186 .

ZHANG Q , ZHOU Y , SONG L J , et al. China special issue on gastrointestinal tumors-Improved survival after multidisciplinary team decision for patients with advanced gastrointestinal cancer: a multicenter, noninterventional, controlled study [J ] . Int J Cancer , 2023 , 153 ( 11 ): 1885 - 1893 .

CAI Z M , LIN H M , LI Z X , et al. The short- and long-term outcomes of laparoscopic D2 lymphadenectomy plus complete mesogastrium excision for lymph node-negative gastric cancer [J ] . Surg Endosc , 2024 , 38 ( 2 ): 1059 - 1068 . DOI: 10.1007/s00464-023-10621-w http://doi.org/10.1007/s00464-023-10621-w

SANDØ A D , GRØNBECH J E , BRINGELAND E A . Does the ypTNM-stage adequately predict long-term survival rates in gastric cancer patients receiving neoadjuvant chemotherapy followed by radical resection? [J ] . Acta Oncol , 2023 , 62 ( 12 ): 1846 - 1853 .

SMYTH E C , NILSSON M , GRABSCH H I , et al. Gastric cancer [J ] . Lancet , 2020 , 396 ( 10251 ): 635 - 648 . DOI: S0140-6736(20)31288-5 http://doi.org/S0140-6736(20)31288-5

ZHANG X J , WANG W Q , ZHAO L L , et al. Short-term safety and long-term efficacy of multivisceral resection in pT4b gastric cancer patients without distant metastasis: a 20-year experience in China National Cancer Center [J ] . J Cancer , 2022 , 13 ( 10 ): 3113 - 3120 . DOI: 10.7150/jca.75456 http://doi.org/10.7150/jca.75456

宋武 , 何裕隆 . 晚期胃癌腹主动脉旁淋巴结转移综合治疗策略 [J ] . 中国实用外科杂志 , 2017 , 37 ( 10 ): 1102 - 1106 . DOI: 10.19538/j.cjps.issn1005-2208.2017.10.09 http://doi.org/10.19538/j.cjps.issn1005-2208.2017.10.09

SONG W , HE Y L . Comprehensive treatment strategies of advanced gastric cancer with para-aortic lymph node metastasis [J ] . Chin J Pract Surg , 2017 , 37 ( 10 ): 1102 - 1106 .

SASAKO M , SANO T , YAMAMOTO S , et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer [J ] . N Engl J Med , 2008 , 359 ( 5 ): 453 - 462 .

LI D B , YOU J , WANG S J , et al. Pancreaticoduodenectomy for locally advanced gastric cancer: results from a pooled analysis [J ] . Asian J Surg , 2019 , 42 ( 3 ): 477 - 481 .

SCHIZAS D , GIANNAKODIMOS I , MYLONAS K S , et al. Multivisceral resection for locally advanced gastric cancer: a systematic review and evidence quality assessment [J ] . J Clin Med , 2023 , 12 ( 23 ): 7360.

KUMAGAI K , NUNOBE S , HIKI N , et al. Anatomical position of the pancreas as a risk factor for pancreatic fistula after laparoscopic gastrectomy for gastric cancer [J ] . World J Surg , 2023 , 47 ( 7 ): 1744 - 1751 . DOI: 10.1007/s00268-023-06972-z http://doi.org/10.1007/s00268-023-06972-z

CAINAP C , NAGY V , SEICEAN A , et al. Results of third-generation epirubicin/cisplatin/xeloda adjuvant chemotherapy in patients with radically resected gastric cancer [J ] . J BUON , 2016 , 21 ( 2 ): 349 - 359 .

LI N , LI Z , FU Q , et al. Efficacy and safety of neoadjuvant sintilimab in combination with FLOT chemotherapy in patients with HER2-negative locally advanced gastric or gastroesophageal junction adenocarcinoma: an investigator-initiated, single-arm, open-label, phase Ⅱ study [J ] . Int J Surg , 2024 , 110 ( 4 ): 2071 - 2084 .

许永虎 , 徐大志 . 21世纪以来胃癌治疗进展及未来展望 [J ] . 中国癌症杂志 , 2024 , 34 ( 3 ): 239 - 249 . DOI: 10.19401/j.cnki.1007-3639.2024.03.001 http://doi.org/10.19401/j.cnki.1007-3639.2024.03.001

XU Y H , XU D Z . Progress and prospects of gastric cancer treatment in the 21st century [J ] . China Oncol , 2024 , 34 ( 3 ): 239 - 249 .

XIA L Z , OYANG L , LIN J G , et al. The cancer metabolic reprogramming and immune response [J ] . Mol Cancer , 2021 , 20 ( 1 ): 28.

BOILÈVE J , TOUCHEFEU Y , MATYSIAK-BUDNIK T . Clinical management of gastric cancer treatment regimens [J ] . Curr Top Microbiol Immunol , 2023 , 444 : 279 - 304 . DOI: 10.1007/978-3-031-47331-9_11 http://doi.org/10.1007/978-3-031-47331-9_11

BOKU N , SATOH T , RYU M H , et al. Nivolumab in previously treated advanced gastric cancer (ATTRACTION-2): 3-year update and outcome of treatment beyond progression with nivolumab [J ] . Gastric Cancer , 2021 , 24 ( 4 ): 946 - 958 . DOI: 10.1007/s10120-021-01173-w http://doi.org/10.1007/s10120-021-01173-w

EISENHAUER E A , THERASSE P , BOGAERTS J , et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1) [J ] . Eur J Cancer , 2009 , 45 ( 2 ): 228 - 247 . DOI: 10.1016/j.ejca.2008.10.026 http://doi.org/10.1016/j.ejca.2008.10.026

TSAGKALIDIS V , BLASZCZYK M B , IN H . Interpretation of tumor response grade following preoperative therapy for gastric cancer: an overview [J ] . Cancers , 2023 , 15 ( 14 ): 3662.

KARABULUT S , DOGAN I , USUL AFSAR C , et al. Does nutritional status affect treatment tolerability, chemotherapy response and survival in metastatic gastric cancer patients? Results of a prospective multicenter study in Turkey [J ] . J Oncol Pharm Pract , 2022 , 28 ( 1 ): 127 - 134 . DOI: 10.1177/1078155220987291 http://doi.org/10.1177/1078155220987291

HUANG C M , LIU H , HU Y F , et al. Laparoscopic vs open distal gastrectomy for locally advanced gastric cancer: five-year outcomes from the CLASS-01 randomized clinical trial [J ] . JAMA Surg , 2022 , 157 ( 1 ): 9 - 17 .

KARPEH M S JR . Palliative treatment and the role of surgical resection in gastric cancer [J ] . Dig Surg , 2013 , 30 ( 2 ): 174 - 180 .

李杨 , 王权 , 叶颖江 , 等 . 应用减量手术治疗无症状不可切除性晚期胃癌疗效meta分析 [J ] . 中国实用外科杂志 , 2022 , 42 ( 1 ): 80 - 86 .

LI Y , WANG Q , YE Y J , et al. Meta-analysis of the efficacy of reduction surgery in incurable asymptomatic advanced gastric cancer [J ] . Chin J Pract Surg , 2022 , 42 ( 1 ): 80 - 86 .

汪学非 , 周鹏 , 唐兆庆 . 胃癌外科治疗的新进展及发展趋势 [J ] . 中国癌症杂志 , 2024 , 34 ( 3 ): 250 - 258 . DOI: 10.19401/j.cnki.1007-3639.2024.03.002 http://doi.org/10.19401/j.cnki.1007-3639.2024.03.002

WANG X F , ZHOU P , TANG Z Q . New progress and development trend of surgical treatment for gastric cancer [J ] . China Oncol , 2024 , 34 ( 3 ): 250 - 258 .

WANG X D , CHEN Y , GAO Y S , et al. Predicting gastric cancer outcome from resected lymph node histopathology images using deep learning [J ] . Nat Commun , 2021 , 12 ( 1 ): 1637.

SONG X H , ZHANG W H , KAI-LIU , et al. Prognostic impact of Borrmann classification on advanced gastric cancer: a retrospective cohort from a single institution in western China [J ] . World J Surg Oncol , 2020 , 18 ( 1 ): 204.

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