早期胃癌药物治疗相关问题
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摘要
早期胃癌以局部治疗为主,包括内镜下切除或根治性手术,但仍有病人术后发生复发转移。对于此类病人如何甄别,如何管理,药物治疗的价值和时机均存在较大争议。临床指南相关规定比较含糊,证据级别不高。临床实践的实际处理策略也存在较大差异。基于目前分子生物学和生信学的进步,随着新药物的研发及上市,药物治疗在早期胃癌中的地位和作用有待重新审视。
Early gastric cancer is mainly treated withradical resection by either endoscopic resection or radical surgery. but there arestill patients finally developrecurrence and metastasis. There are arguments on how to identify these patients with poor prognosis,and how to manage the treatment,and the value and timing ofanticancer therapeutic agents. Because of low level of evidence, the current clinical guidelines are relatively vague on these questions, and oncologists differ in treatment optionin real world. The role of anticancer therapeutic agents in early gastric cancer needs to be re-examined given the advances in molecular biology,bioinformatics and new drugs.
Early gastric cancer is mainly treated withradical resection by either endoscopic resection or radical surgery. but there arestill patients finally developrecurrence and metastasis. There are arguments on how to identify these patients with poor prognosis,and how to manage the treatment,and the value and timing ofanticancer therapeutic agents. Because of low level of evidence, the current clinical guidelines are relatively vague on these questions, and oncologists differ in treatment optionin real world. The role of anticancer therapeutic agents in early gastric cancer needs to be re-examined given the advances in molecular biology,bioinformatics and new drugs.
引文
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[12]Chalabi M,Fanchi LF,van Den Berg J,et al.Neoadjuvant ipilimumab plus nivolumab in early stage colon cancer[J].Ann Oncol,2018,29:731-731.
[2]Fan SX,Feng M,Wang M,et al.Extensive small bowel metastasis and peritoneal dissemination 1 year following curative gastrectomy for T1N1 gastric cancer A case report[J].Medicine2019,98(5):5.
[3]Namikawa T,Ishida N,Tsuda S,et al.Successful treatment of liver metastases arising from early gastric cancer achieved clinical complete response by nivolumab[J].Surg Case Rep,2018,4(1):71.
[4]Ito S,Ohashi Y,Sasako M.Survival after recurrence in patients with gastric cancer who receive S-1 adjuvant chemotherapy:exploratory analysis of the ACTS-GC trial[J].BMC Cancer,201818(1):449..
[5]Kim SM,An JY,Lee J,et al.Adjuvant Chemotherapy Versus Chemoradiotherapy Versus Surgery Alone for Early Gastric Cancer with One or Two Lymph Node Metastasis[J].Ann Surg Oncol,2018,25(6):1616-1624.
[6]Takizawa K,Hatta W,Gotoda T,et al.Recurrence patterns and outcomes of salvage surgery in cases of non-curative endoscopic submucosal dissection without additional radical surgery for early gastric cancer[J].Digestion,2019,99(1):52-58.
[7]Li J,Qin SK,Xu JM,et al.Randomized,double-blind,placebocontrolled phase III trial of apatinib in patients with chemotherapy-refractory advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction[J].J Clin Oncol,2016,34(13):1448-1454.
[8]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(vol 376,pg 687,2010)[J].Lancet,2010,376(9749):1302-1302.
[9]Cristescu R,Lee J,Nebozhyn M,et al.Molecular analysis of gastric cancer identifies subtypes associated with distinct clinical outcomes[J].Nat Med,2015,21(5):449-U217.
[10]Bass A J,Thorsson V,Shmulevich I,et al.Comprehensive molecular characterization of gastric adenocarcinoma[J].Nature,2014,513(7517):202-209.
[11]Cho J,Chang YH,Heo YJ,et al.Four distinct immune microenvironment subtypes in gastric adenocarcinoma with special reference to microsatellite instability[J].Esmo Open,2018,3(3):e000326.
[12]Chalabi M,Fanchi LF,van Den Berg J,et al.Neoadjuvant ipilimumab plus nivolumab in early stage colon cancer[J].Ann Oncol,2018,29:731-731.