Updates in standard management of gastric cancer_West China Medical Journal

Authors：

CHEN Xinzu ,  HU Jiankun

Department of Gastrointestinal Surgery / Laboratory of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

HU Jiankun, Email: hujkwch@126.com

Keywords：

Gastric cancer; Esophagogastric junction cancer; Standardization; Guideline; Multidisciplinary

DOI：

10.7507/1002-0179.201803214

Video：

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The diagnosis and treatment of gastric cancer is a systematic and frameworking medical task in a multidisciplinary manner. New models, new technologies, new regimens, and new drugs have been developed to explore the best strategies to improve the survival of patients with gastric cancer. Here we discussed the research progress and guideline updates in four aspects, including the accurate staging-classification-based treatment strategy, the quality control in the surgery, the rational perioperative neoadjuvant-adjuvant therapies, and molecular classification joint with precision medicine. The purpose is to further promote the standardized gastric cancer management in China and emphasize its importance. From the updates of knowledge and the transformation of understanding and recognition, to the quality improvement, it’s critical to reduce the heterogeneity of the quality of gastric cancer management in China, as well as enhance adherence to guidelines and consensuses.

Citation： CHEN Xinzu, HU Jiankun. Updates in standard management of gastric cancer. West China Medical Journal, 2018, 33(4): 379-384. doi: 10.7507/1002-0179.201803214 Copy

1.	Chen XZ, Liu Y, Wang R, et al. Improvement of cancer control in mainland China: epidemiological profiles during the 2004-10 National Cancer Prevention and Control Program. Lancet, 2016, 388(suppl 1): S40.
2.	胡建昆, 陈心足. 胃癌多学科协作诊疗模式现状. 中国普外基础与临床杂志, 2012, 19(1): 1-3.
3.	National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): gastric cancer (Version 1.2018).(2018-03-16)[2018-03-20]. www.nccn.org.
4.	Ji X, Bu ZD, Yan Y, et al. The 8th edition of the American Joint Committee on Cancer tumor-node-metastasis staging system for gastric cancer is superior to the 7th edition: results from a Chinese mono-institutional study of 1663 patients. Gastric Cancer, 2017. https://doi.org/10.1007/s10120-017-0779-5.
5.	In H, Solsky I, Palis B, et al. Validation of the 8th edition of the AJCC TNM staging system for gastric cancer using the national cancer database. Ann Surg Oncol, 2017, 24(12): 3683-3691.
6.	Kim SG, Seo HS, Lee HH, et al. Comparison of the differences in survival rates between the 7th and 8th editions of the AJCC TNM staging system for gastric adenocarcinoma: a single-institution study of 5,507 patients in Korea. J Gastric Cancer, 2017, 17(3): 212-219.
7.	Lu J, Zheng CH, Cao LL, et al. The effectiveness of the 8th American Joint Committee on Cancer TNM classification in the prognosis evaluation of gastric cancer patients: a comparative study between the 7th and 8th editions. Eur J Surg Oncol, 2017, 43(12): 2349-2356.
8.	Yang K, Choi YY, Zhang WH, et al. Strategies to improve treatment outcome in gastric cancer: a retrospective analysis of patients from two high-volume hospitals in Korea and China. Oncotarget, 2016, 7(28): 44660-44675.
9.	Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review. J Clin Oncol, 2007, 25(15): 2107-2116.
10.	中国抗癌协会胃癌专业委员会. 胃癌腹膜转移防治中国专家共识. 中华普通外科学文献: 电子版, 2017, 11(5): 289-297.
11.	胡建昆, 张维汉, 陈心足. 从中国 CLASS-03a 研究的开展看腹腔镜手术联合新辅助化疗的胃癌治疗. 中华胃肠外科杂志, 2018, 21(2): 138-142.
12.	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4) Gastric Cancer, 2017, 20(1): 1-19.
13.	Zhang WH, Chen XZ, Liu K, et al. Comparison of survival outcomes between transthoracic and transabdominal surgical approaches in patients with Siewert-Ⅱ/Ⅲ esophagogastric junction adenocarcinoma: a single-institution retrospective cohort study. Chin J Cancer Res, 2016, 28(4): 413-422.
14.	Sasako M, Sano T, Yamamoto S, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol, 2006, 7(8): 644-651.
15.	Kurokawa Y, Sasako M, Sano T, et al. Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg, 2015, 102(4): 341-348.
16.	Sasako M, Sano T, Yamamoto S, et al. D₂ lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med, 2008, 359(5): 453-462.
17.	Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol, 2010, 11(5): 439-449.
18.	Worhunsky DJ, Ma YF, Zak Y, et al. Compliance with gastric cancer guidelines is associated with improved outcomes. J Natl Compr Canc Netw, 2015, 13(3): 319-325.
19.	Morgan JW, Ji L, Friedman G, et al. The role of the cancer center when using lymph node count as a quality measure for gastric cancer surgery. JAMA Surg, 2015, 150(1): 37-43.
20.	Chen XZ, Zhang WH, Hu JK. A difficulty in improving population survival outcome of gastric cancer in mainland China: low proportion of early diseases. Med Oncol, 2014, 31(12): 315.
21.	Hu Y, Huang C, Sun Y, et al. Morbidity and mortality of laparoscopic versus open D₂ distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol, 2016, 34(12): 1350-1357.
22.	中国医师协会内镜医师分会腹腔镜外科专业委员会, 中国研究型医院学会机器人与腹腔镜外科专业委员会, 中国腹腔镜胃肠外科研究组. 中国腹腔镜胃癌根治手术质量控制专家共识(2017 版). 中华消化外科杂志, 2017, 16(6): 539-545.
23.	胡建昆, 杨昆, 陈心足, 等. 顺向式模块化淋巴结清扫在腹腔镜胃癌手术中的应用. 中华胃肠外科杂志, 2017, 20(2): 200-206.
24.	GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group, Paoletti X, Oba K, et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA, 2010, 303(17): 1729-1737.
25.	Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med, 2007, 357(18): 1810-1820.
26.	Noh SH, Park SR, Yang HK, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D₂ gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol, 2014, 15(12): 1389-1396.
27.	Kim IH, Park SS, Lee CM, et al. Efficacy of adjuvant S-1 versus XELOX chemotherapy for patients with gastric cancer after D₂ lymph node dissection: a retrospective, multi-center observational study. Ann Surg Oncol, 2018. https://doi.org/10.1245/s10434-018-375-z.
28.	Shitara K, Chin K, Yoshikawa T, et al. Phase Ⅱ study of adjuvant chemotherapy of S-1 plus oxaliplatin for patients with stage Ⅲ gastric cancer after D₂ gastrectomy. Gastric Cancer, 2017, 20(1): 175-181.
29.	Yang L, Yang Y, Qin Q, et al. Evaluation of the optimal dosage of S-1 in adjuvant SOX chemotherapy for gastric cancer. Oncol Lett, 2015, 9(3): 1451-1457.
30.	Chen XZ, Yang K, Liu J, et al. Neoadjuvant plus adjuvant chemotherapy benefits overall survival of locally advanced gastric cancer. World J Gastroenterol, 2011, 17(40): 4542-4544.
31.	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer, 2011, 14(2): 113-123.
32.	Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med, 2006, 355(1): 11-20.
33.	Ychou M, Boige V, Pignon JP, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase Ⅲ trial. J Clin Oncol, 2011, 29(13): 1715-1721.
34.	Smyth EC, Verheij M, Allum W, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2016, 27(5): v38-v49.
35.	Zhang WH, Chen XZ, Liu K, et al. Outcomes of surgical treatment for gastric cancer patients: 11-year experience of a Chinese high-volume hospital. Med Oncol, 2014, 31(9): 150.
36.	Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed intergroup study 0116: a phase Ⅲ trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol, 2012, 30(19): 2327-2333.
37.	Park SH, Sohn TS, Lee J, et al. Phase Ⅲ trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer: final report of the adjuvant chemoradiotherapy in stomach tumors trial, including survival and subset analyses. J Clin Oncol, 2015, 33(28): 3130-3136.
38.	Shapiro J, van Lanschot JJ, Hulshof MC, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16(9): 1090-1098.
39.	Stahl M, Walz MK, Stuschke M, et al. Phase Ⅲ comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol, 2009, 27(6): 851-856.
40.	Bartley AN, Washington MK, Colasacco CA, et al. HER2 testing and clinical decision making in gastroesophageal adenocarcinoma: guideline from the college of American pathologists, American society for clinical pathology, and the American society of clinical oncology. J Clin Oncol, 2017, 35(4): 446-464.
41.	Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet, 2010, 376(9742): 687-697.
42.	Le DT, Durham JN, Smith KN, et al. Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science, 2017, 357(6349): 409-413.
43.	Le DT, Uram JN, Wang H, et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med, 2015, 372(26): 2509-2520.
44.	Fuchs CS, DoiT, Jang RW, et al. KEYNOTE-059 cohort 1: efficacy and safety of pembrolizumab (pembro) monotherapy in patients with previously treated advanced gastric cancer J Clin Oncol, 2017, 35(Suppl 15): 4003.
45.	Bang YJ, Muro K, Fuchs CS, et al. KEYNOTE-059 cohort 2: safety and efficacy of pembrolizumab (pembro) plus 5-fluorouracil (5-FU) and cisplatin for first-line (1L) treatment of advanced gastric cancer J Clin Oncol, 2017, 35(Suppl 15): 4012.
46.	Li J, Qin S, Xu J, et al. Randomized, double-blind, placebo-controlled phase Ⅲ trial of apatinib in patients with chemotherapy-refractory advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction. J Clin Oncol, 2016, 34(13): 1448-1454.

1. Chen XZ, Liu Y, Wang R, et al. Improvement of cancer control in mainland China: epidemiological profiles during the 2004-10 National Cancer Prevention and Control Program. Lancet, 2016, 388(suppl 1): S40.
2. 胡建昆, 陈心足. 胃癌多学科协作诊疗模式现状. 中国普外基础与临床杂志, 2012, 19(1): 1-3.
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): gastric cancer (Version 1.2018).(2018-03-16)[2018-03-20]. www.nccn.org.
4. Ji X, Bu ZD, Yan Y, et al. The 8th edition of the American Joint Committee on Cancer tumor-node-metastasis staging system for gastric cancer is superior to the 7th edition: results from a Chinese mono-institutional study of 1663 patients. Gastric Cancer, 2017. https://doi.org/10.1007/s10120-017-0779-5.
5. In H, Solsky I, Palis B, et al. Validation of the 8th edition of the AJCC TNM staging system for gastric cancer using the national cancer database. Ann Surg Oncol, 2017, 24(12): 3683-3691.
6. Kim SG, Seo HS, Lee HH, et al. Comparison of the differences in survival rates between the 7th and 8th editions of the AJCC TNM staging system for gastric adenocarcinoma: a single-institution study of 5,507 patients in Korea. J Gastric Cancer, 2017, 17(3): 212-219.
7. Lu J, Zheng CH, Cao LL, et al. The effectiveness of the 8th American Joint Committee on Cancer TNM classification in the prognosis evaluation of gastric cancer patients: a comparative study between the 7th and 8th editions. Eur J Surg Oncol, 2017, 43(12): 2349-2356.
8. Yang K, Choi YY, Zhang WH, et al. Strategies to improve treatment outcome in gastric cancer: a retrospective analysis of patients from two high-volume hospitals in Korea and China. Oncotarget, 2016, 7(28): 44660-44675.
9. Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review. J Clin Oncol, 2007, 25(15): 2107-2116.
10. 中国抗癌协会胃癌专业委员会. 胃癌腹膜转移防治中国专家共识. 中华普通外科学文献: 电子版, 2017, 11(5): 289-297.
11. 胡建昆, 张维汉, 陈心足. 从中国 CLASS-03a 研究的开展看腹腔镜手术联合新辅助化疗的胃癌治疗. 中华胃肠外科杂志, 2018, 21(2): 138-142.
12. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4) Gastric Cancer, 2017, 20(1): 1-19.
13. Zhang WH, Chen XZ, Liu K, et al. Comparison of survival outcomes between transthoracic and transabdominal surgical approaches in patients with Siewert-Ⅱ/Ⅲ esophagogastric junction adenocarcinoma: a single-institution retrospective cohort study. Chin J Cancer Res, 2016, 28(4): 413-422.
14. Sasako M, Sano T, Yamamoto S, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol, 2006, 7(8): 644-651.
15. Kurokawa Y, Sasako M, Sano T, et al. Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg, 2015, 102(4): 341-348.
16. Sasako M, Sano T, Yamamoto S, et al. D₂ lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med, 2008, 359(5): 453-462.
17. Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol, 2010, 11(5): 439-449.
18. Worhunsky DJ, Ma YF, Zak Y, et al. Compliance with gastric cancer guidelines is associated with improved outcomes. J Natl Compr Canc Netw, 2015, 13(3): 319-325.
19. Morgan JW, Ji L, Friedman G, et al. The role of the cancer center when using lymph node count as a quality measure for gastric cancer surgery. JAMA Surg, 2015, 150(1): 37-43.
20. Chen XZ, Zhang WH, Hu JK. A difficulty in improving population survival outcome of gastric cancer in mainland China: low proportion of early diseases. Med Oncol, 2014, 31(12): 315.
21. Hu Y, Huang C, Sun Y, et al. Morbidity and mortality of laparoscopic versus open D₂ distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol, 2016, 34(12): 1350-1357.
22. 中国医师协会内镜医师分会腹腔镜外科专业委员会, 中国研究型医院学会机器人与腹腔镜外科专业委员会, 中国腹腔镜胃肠外科研究组. 中国腹腔镜胃癌根治手术质量控制专家共识(2017 版). 中华消化外科杂志, 2017, 16(6): 539-545.
23. 胡建昆, 杨昆, 陈心足, 等. 顺向式模块化淋巴结清扫在腹腔镜胃癌手术中的应用. 中华胃肠外科杂志, 2017, 20(2): 200-206.
24. GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group, Paoletti X, Oba K, et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA, 2010, 303(17): 1729-1737.
25. Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med, 2007, 357(18): 1810-1820.
26. Noh SH, Park SR, Yang HK, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D₂ gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol, 2014, 15(12): 1389-1396.
27. Kim IH, Park SS, Lee CM, et al. Efficacy of adjuvant S-1 versus XELOX chemotherapy for patients with gastric cancer after D₂ lymph node dissection: a retrospective, multi-center observational study. Ann Surg Oncol, 2018. https://doi.org/10.1245/s10434-018-375-z.
28. Shitara K, Chin K, Yoshikawa T, et al. Phase Ⅱ study of adjuvant chemotherapy of S-1 plus oxaliplatin for patients with stage Ⅲ gastric cancer after D₂ gastrectomy. Gastric Cancer, 2017, 20(1): 175-181.
29. Yang L, Yang Y, Qin Q, et al. Evaluation of the optimal dosage of S-1 in adjuvant SOX chemotherapy for gastric cancer. Oncol Lett, 2015, 9(3): 1451-1457.
30. Chen XZ, Yang K, Liu J, et al. Neoadjuvant plus adjuvant chemotherapy benefits overall survival of locally advanced gastric cancer. World J Gastroenterol, 2011, 17(40): 4542-4544.
31. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer, 2011, 14(2): 113-123.
32. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med, 2006, 355(1): 11-20.
33. Ychou M, Boige V, Pignon JP, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase Ⅲ trial. J Clin Oncol, 2011, 29(13): 1715-1721.
34. Smyth EC, Verheij M, Allum W, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2016, 27(5): v38-v49.
35. Zhang WH, Chen XZ, Liu K, et al. Outcomes of surgical treatment for gastric cancer patients: 11-year experience of a Chinese high-volume hospital. Med Oncol, 2014, 31(9): 150.
36. Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed intergroup study 0116: a phase Ⅲ trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol, 2012, 30(19): 2327-2333.
37. Park SH, Sohn TS, Lee J, et al. Phase Ⅲ trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer: final report of the adjuvant chemoradiotherapy in stomach tumors trial, including survival and subset analyses. J Clin Oncol, 2015, 33(28): 3130-3136.
38. Shapiro J, van Lanschot JJ, Hulshof MC, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16(9): 1090-1098.
39. Stahl M, Walz MK, Stuschke M, et al. Phase Ⅲ comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol, 2009, 27(6): 851-856.
40. Bartley AN, Washington MK, Colasacco CA, et al. HER2 testing and clinical decision making in gastroesophageal adenocarcinoma: guideline from the college of American pathologists, American society for clinical pathology, and the American society of clinical oncology. J Clin Oncol, 2017, 35(4): 446-464.
41. Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet, 2010, 376(9742): 687-697.
42. Le DT, Durham JN, Smith KN, et al. Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science, 2017, 357(6349): 409-413.
43. Le DT, Uram JN, Wang H, et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med, 2015, 372(26): 2509-2520.
44. Fuchs CS, DoiT, Jang RW, et al. KEYNOTE-059 cohort 1: efficacy and safety of pembrolizumab (pembro) monotherapy in patients with previously treated advanced gastric cancer J Clin Oncol, 2017, 35(Suppl 15): 4003.
45. Bang YJ, Muro K, Fuchs CS, et al. KEYNOTE-059 cohort 2: safety and efficacy of pembrolizumab (pembro) plus 5-fluorouracil (5-FU) and cisplatin for first-line (1L) treatment of advanced gastric cancer J Clin Oncol, 2017, 35(Suppl 15): 4012.
46. Li J, Qin S, Xu J, et al. Randomized, double-blind, placebo-controlled phase Ⅲ trial of apatinib in patients with chemotherapy-refractory advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction. J Clin Oncol, 2016, 34(13): 1448-1454.

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