日本《胃癌处理规约》及《胃癌治疗指南》变更的新动态

日本《胃癌处理规约》及《胃癌治疗指南)（以下分别简称“规约”、“指南”）与时俱进,迅速筛选汲取新研究、新理念,及时进行充实修订,对全球胃癌诊治具有重大影响。“第88届日本胃癌学会年会”对“规约”和“指南”修订要点进行了讨论。“规约”将对胃区域淋巴结的亚组分类、胃癌腹膜转移程度判定标准、病理学分类等相关内容进行补充和修订。“指南”部分主要集中在化学疗法（推荐新的药物及化疗方案）、内镜治疗（内镜切除适应证范围扩大）和指南的文书形式方面。修订后新版“规约”及“指南”将于2017年出版。此次修订汇集了当今最新的科学研究成果, 将对胃癌临床诊疗产生重要影响。     

2015年V1版《NCCN胃癌临床实践指南》更新解读

胃癌诊治领域近年来进展迅速,《NCCN胃癌临床实践指南》（《指南》）也不断推出新的版本,以跟进最新的前沿进展。2015年V1版《指南》在原来的基础上引进了新的证据和标准,从四个主要方面进行了修订: (1)更新了“胃癌不可根治性切除的标准”;(2)修改了胃癌的风险分析,新增了“肿瘤风险评估”和“遗传学咨询”;(3)修改了局部进展期、局部复发或转移性胃癌的部分化疗方案;(4)修改了胃癌放疗的部分内容。新版《指南》对胃癌的治疗理念更规范化、科学化,为今后的临床实践提供指导。     

日本第15版《胃癌处理规约》及第5版《胃癌治疗指南》更新内容解读

日本《胃癌处理规约》及《胃癌治疗指南》(以下分别简称规约和指南)对全球胃癌诊治具有重大影响,且其迅速筛选并汲取新研究、新理念,及时进行充实修订。在2016年和2017年的第88、89届日本胃癌学会年会,分别对规约和指南再度修订要点进行了严谨而深入的讨论。规约对胃区域淋巴结的亚分类、胃癌腹膜转移程度的判定标准、病理学分类等相关内容进行补充和修订。指南更新部分主要集中在外科治疗、化疗(推荐新的药物及化疗方案)、内镜治疗(内镜切除适应证扩大)和指南的文书形式方面。修订后新版规约及指南将于2017年出版。此次修订汇集当今最新的科学研究成果,将对胃癌临床诊治产生重要影响。     

“第89届日本胃癌学会年会”特别演讲重要内容介绍

第5版日本《胃癌治疗指南》缩小了胃癌标准手术的切除范围,不推荐对近端非大弯侧胃癌行脾切除,对于c T3/4期胃癌不推荐行网膜囊切除。对于IV期病例,不推荐手术+化疗的治疗模式,化疗+手术可能是选项之一。扩大了早期胃癌行内镜黏膜下剥离术(ESD)的绝对适应证。增加了新的化疗药物、靶向药物和化疗方案,例如奥沙利铂和RAM单抗被批准用于胃癌的化疗和靶向治疗。扩大了卡培他滨和奥沙利铂用于围手术期化疗的适应证。选择了30~40个临床问题,经过讨论后给予最可能的回答。第15版日本《胃癌处理规约》与第8版国际抗癌联盟/美国癌症联合委员会(UICC/AJCC)胃癌分期系统进行了整合,该分期是基于国际胃癌学会胃癌TNM分期项目的结果修订的,第一次体现了国际化。第15版日本《胃癌处理规约》修订了幽门下组淋巴结,将其分成No.6a、No.6v和No.6i三个亚组。对腹膜转移分级进行修订,将P1按转移范围进一步分成P1a、P1b和P1c。如果胃窦癌侵犯十二指肠,No.13淋巴结发生转移,应该视为区域淋巴结转移,不做为M1对待。传统意义的R0不适用于对ESD手术质量的评估。食管胃结合部癌的诊断标准应该结合内镜所见、上消化道造影及病理诊断。对化疗疗效评价标准进行修订,确定了肿瘤消退的界值为10%。     

胃癌微创外科临床研究进展及展望（2000-2020）

目前临床研究已证实腹腔镜胃癌根治术治疗早期胃癌的安全性、可行性和有效性。基于此，第4版日本《胃癌治疗指南》推荐腹腔镜手术治疗临床Ⅰ期远端胃癌。然而，腹腔镜胃癌手术治疗进展期胃癌的有效性和安全性仍存争议。中国腹腔镜胃肠外科研究组（CLASS研究组）发起的CLASS-01研究顺利完成，提供了全球首个局部进展期胃癌腹腔镜手术安全性和疗效的前瞻性多中心证据。胃癌外科的主流方向在从“大切口和扩大化手术切除”逐渐向“微创、精准化手术”转变，以使手术安全性和病人术后生活质量最优化。     

第15版日本《胃癌处理规约》及第5版《胃癌治疗指南》部分内容解读——“第90届日本胃癌学会年会”报道

第15版日本《胃癌处理规约》对胃癌分期修订了幽门下组淋巴结,将其分成No.6a、No.6v和No.6i 3个亚组。对腹膜转移分级进行修订,将P1按转移范围进一步分成P1a、P1b和P1c。如果胃窦癌侵犯十二指肠,No.13淋巴结发生转移,应该视为区域淋巴结转移。将No.14v重新归为区域淋巴结,但是未包含在D2清扫范围。重新界定了食管胃结合部癌的定义。食管胃结合部癌的诊断标准应该结合内镜所见、上消化道造影及病理学诊断。明确了SiewertⅢ型食管胃结合部癌遵循胃癌TNM分期。第5版日本《胃癌治疗指南》继续采取Minds模式一共归纳了26个临床问题,最终经过指南委员会的充分讨论并给出推荐意见。不推荐姑息手术+化疗的治疗模式,不推荐对近端非大弯侧胃癌进行脾切除,对于c T3/4期胃癌不推荐网膜囊切除。扩大了腹腔镜的手术适应证。对于选择性病例,可以采取新辅助化疗+扩大根治手术,或联合切除模式。     

从日本《胃癌治疗指南》（第5版）修订谈日本胃癌外科发展趋势

日本《胃癌治疗指南》自2001年3月制定以来进行了5次修订,其建立在日本大量经验性数据基础上,采用教科书形式介绍,但第5版《胃癌治疗指南》体现出从经验外科向循证医学外科的转变,包括非治愈性胃癌的减瘤手术、网膜囊外切除、近端和胃体部癌合并脾切除、胃癌侵犯食管的手术入路问题等,采纳了国际多中心临床试验（MRCT）研究结果。推荐cStageⅠ胃癌为腹腔镜手术适应证,而对于进展期胃癌正在进行MRCT（JLSSG0901）研究,有待结果发表。改变单一手术模式,注重术前新辅助化疗,对于临界可切除的高度淋巴结转移病例,进行新辅助化疗（SP方案）2~3疗程后,再行D2+No.16淋巴结清扫。对于胃癌腹膜转移的腹腔镜诊断标准以及食管胃结合部癌和残胃癌区域淋巴结定义和清扫范围,指南提出了日本标准,有待循证医学检验。     

日本《胃癌治疗指南》的变更与胃癌治疗新动向

日本《胃癌治疗指南》（以下简称指南）目前已成为胃癌临床治疗的重要指导性文件，其每次更新均成为全球胃癌领域的重大事件，备受瞩目。2018年第5版指南发行，2019年2月在日本静冈召开的“第91届日本胃癌学会年会”再度对相关内容进行了严谨而深刻的讨论，提出了新的修改意见。随着新的循证医学证据的出现，指南也在不断更新，胃癌的治疗方式也不断与时俱进。     

日本《胃癌治疗指南》（第3版）解读

日本胃癌学会的第3版《胃癌治疗指南》将于2010?01?01起发行使用。第3版的主要内容是废止了以往在日本长期使用的解剖学N分期（淋巴结站的分类）方法,改为根据淋巴结转移个数确定的N分期方法;制定了新的以术式确定淋巴结清扫部位及简明的D1/D2淋巴结清扫手术。第3版在前两版的基础上,网络新的文献,评价最新的科学成果,将循证医学证据高级别的、行之有效的研究成果纳入《胃癌治疗指南》。第3版《胃癌治疗指南》依据JCOG9501试验结果,取消腹主动脉周围淋巴结清扫的D3手术;依据JCOG9912和SPIRITS试验,将无法手术切除和复发癌采取CDDP+TS?1的化学疗法作为标准化学疗法。因此,第3版《胃癌治疗指南》更具有时代特色和先进性,为临床医疗提供了更为先进的、科学的指导性意见和治疗方略。     

第4版日本《胃癌治疗指南》中7个“临床问题”解析

第4版日本《胃癌治疗指南》提出,对无其他非治愈因素的3种能切除的M1病变的胃癌施行手术+化疗的综合治疗。即,胃切除+No.16a2、b1肿大淋巴结扩大清扫术;CY1病例行胃癌根治切除+围手术期化疗,均取得较好疗效。对少数转移灶的胃癌肝转移,提倡包括外科切除的综合治疗。对难以适用标准化疗的4种晚期胃癌均提出了值得重视的有价值疗法。     

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??Japanese gastric cancer treatment guidelines-the 4th Edition 2014 update message HU Xiang. Department of General Surgery??the First Affiliated Hospital??Dalian Medical University??Dalian 116011??China
Abstract The launch of Japanese gastric cancer treatment guidelines ( the following as guide) -the 3rd Edition in 2010 has produced a great effect on the surgical treatment of gastric cancer. The treatment of gastric cancer is more standardized, rationalized and normalized. In recent years, new research results made "guide" revised and reedited. In the new "guide" of the 4th Edition 2014, seven major problems were revised on the basis of the previous “guide”. New evidence and standards were introduced (the definition of gastric operation was updated; temporary provisions and flow chart were enacted for the lymph node dissection when the size of esogastric junction adenocarcinoma is smaller than 4cm; laparoscopic distal gastrectomy was considered to be the conventional treatment for stage I gastric cancer; the relevant standards under gastroscope therapy; the recommended degree of chemotherapy ; the recommended scheme and flow chart for HER2-negative and HER2-positive gastric carcinoma; the relevant provisions of the operation, chemotherapy and follow-up for gastric cancer of stage M1). The "guide"- the 4th edition has acquired the latest scientific achievements, which makes the basic principles for the treatment of gastric cancer and the concept more scientific and accurate. It will provide important guidance for the future clinical practice.     

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??Explanation of the 7 clinical questions in Japanese gastric cancer treatment guidelines——the 4th edition 2014 CHEN Jun-qing. Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
Abstract Japanese gastric cancer treatment guide lines -the 4th Edition has proposed a solution for 3 kinds of patients with resectable M1 disease and without any other non-curative factors. They are scheduled to receive combined treatment -operation and chemotherapy. For example, patients who are scheduled to receive gastrectomy with extended lymphadenectomy (No.16a2??b1). Patients with CY1 disease, who are proposed to receive radical resection as routines, have achieved better results, combined with paraoperational chemotherapy. Patients with a small number of liver metastases are recommended with surgical therapy combined with systemic treatment. The guide provided effective treatments, which deserve attention, considered for patients with four kinds of advanced gastric cancer that are not applicable to standard chemotherapy.     

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??New treatment modalities for Japanese gastric cancer treatment guidelines and classification HU Xiang. Ddepartment of Gastrointestinal Surgery . the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China
Abstract The Japanese Gastric Cancer Treatment Guidelines (referred to as Guidelines) and Japanese Classification of gastric carcinoma(referred to as Classification) have a significant impact on the global treatment for gastric cancer. Based on the latest research results, "classification" and "guidelines" will be revised again in 2017. In 2016 , The88th Japanese gastric cancer association discussed the future revisions, protocol will revise the sub classification of regional lymph nodes, the criteria of peritoneal metastasis, pathological classification and other related content complement. The "guidelines" part mainly focused on chemical therapy (recommend new drugs and chemotherapy), endoscopic treatment (indication expanded). The revised version of the "classification" and "guidelines" will be published in 2017, the revision is based on the latest research results, will have a significant impact on clinical diagnosis and treatment.     

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??In regard to japanese gastric cancer treatment guidelines-the 3rd Edition HU Xiang. Department of General Surgery??the first Affiliated Hospital??Dalian Medical University??Dalian 116011??China Abstract The Japanese Gastric Cancer Association will issue a revised edition of gastric cancer treatment guidelines in Jan, 1st, 2010. Distinctive features of this revision are lymph node grading based on the removal effect, lymphadenectomy according to the D1/D2 dissection. Based on a high level evidence-based medicine, the Para-aortic lymph node dissection in D3 dissection was excluded in this edition. According to JCOG9912 and SPIRITS trials, neoadjuvant chemotherapy with CDDP and TS-1 has become a standard option in unresectable or recurrent gastric cancer. So the revised edition of gastric cancer treatment guidelines provided more advanced and scientific treatment programs.     

第5版日本《胃癌治疗指南》解读

日本胃癌学会的第5版《胃癌治疗指南）》于2018-01-31正式发行。第5版指南在胃癌的手术治疗、内镜治疗、化学疗法等方面均有不同程度的更新,在第4版的基础上,更加注重循证医学证据,胃癌治疗的指征和方案更加细致,是一部更加适合推荐,能够帮助临床医生制定临床决策的高度重要性的指南。其不仅在日本,在国际上也有重要的影响,充分掌握其精神和内容,制定符合我国的诊治指南,对于推动我国胃癌的规范化诊治具有重要意义。     

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??New treatment modalities for Japanese gastric cancer treatment guidelines and classification HU Xiang. Department of Gastrointestinal Surgery??the First Affiliated Hospital of Dalian Medical University??Dalian 116011??China
Abstract The Japanese Gastric Cancer Treatment Guidelines (referred to as Guidelines) and Japanese Classification of gastric carcinoma(referred to as Classification) have a significant impact on the global treatment for gastric cancer. Based on the latest research results??classification and guidelines will be revised again in 2017. In 2016 and 2017??the 88th and 89th Japanese gastric cancer association discussed the future revisions??protocol will revise the sub classification of regional lymph nodes??the criteria of peritoneal metastasis??pathological classification and other related content complement. The guidelines part mainly focused on surgery treatment??chemical therapy (recommend new drugs and chemotherapy)??endoscopic treatment (indication expanded). The revised version of the classification and guidelines will be published in 2017??the revision is based on the latest research results??will have a significant impact on clinical diagnosis and treatment.     

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??Updated contents of Japanese classification of gastric cancer-the 15th Edition SUO Jian. Department of Gastric and Colorectal Surgery, First Hospital of Jilin University, Changchun 130021, China
Abstract The 89th annual meeting of the Japanese gastric cancer association was held on 7th-9th Mar, 2017 in Japan. The meeting released the revised contents of Japanese Classification of Gastric Carcinoma--the 15th Edition. New edition released anatomical definitions of the infrapyloric lymph node (No.6 lymph node station), reclassification the peritoneal metastasis and explain the lymph node metastasis in the duodenal invasion of gastric cancer; New edition also explain the different R concept in endoscopic resection and explain the definition of Esophago-gastric junction cancer and associated lymph nodes; At last it reregulated the recordation of pathology contents, such as TNM staging, lymphatic invasion, venous invasion and the histologic effect of chemoradiotherapy. . the updated contents of Japanese classification of gastric cancer-the 15th Edition reflects the latest knowledge of gastric cancer, and provide great reference value for the diagnosis and treatment of gastric cancer and the revised content of Japanese gastric cancer treatment guidelines     

第6版日本《胃癌治疗指南》拔萃

日本胃癌学会组织撰写的第6版《胃癌治疗指南》（以下为指南）于2021年7月正式出版发行。第6版指南在充分论证、讨论基础上,吸纳了最新高级别循证医学证据,规范充实了外科手术、内镜治疗、化疗、术后随诊等方面内容,更具时代特色和先进性,为今后临床医疗提供更为精确、科学的指导性意见和策略。     

第6版日本《胃癌治疗指南》更新要点解读

日本《胃癌治疗指南》是日本乃至全球胃癌治疗领域的重要指导性文件,其临床意义重大。2021年3月"第93届日本胃癌学会年会"于线上召开,对2018年以来胃癌治疗的新方法、新思路、新探索进行了总结,并以此为基础对第5版《胃癌治疗指南》进行更新,于2021年7月出版。新版指南在胃癌内镜治疗、手术治疗、化疗的适应证、推荐方案等方面均有不同程度的更新。