《The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2023》于 2024 年发表在《Cancer Communications》期刊上，DOI 为 10.1002/cac2.12516。该指南聚焦中国胃癌诊疗规范化，结合中外临床研究成果，针对东西方胃癌患者的差异优化诊疗方案，以下是其核心内容的整理：
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Diagnosis
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Imaging Diagnosis：A structured template for imaging diagnosis reports is established. Contrast-enhanced CT of the chest, abdomen and pelvis is the basic method for preoperative staging. MRI, laparoscopic exploration and PET are alternative means when liver metastasis, peritoneal metastasis and systemic metastasis are suspected by CT respectively. Endoscopic ultrasonography is the preferred tool for T-staging, which can clearly show the invasion depth of the lesion and the condition of perigastric lymph nodes.
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Pathological and Molecular Diagnosis：Endoscopic biopsy histopathological diagnosis is the basis for confirming gastric cancer. For surgical specimens, at least 16 lymph nodes should be detected, and preferably 30, to ensure accurate N-staging. In terms of molecular testing, HER2 testing is routinely recommended. Additionally, immunohistochemical testing of Claudin18.2 is newly added as a grade III recommendation with category 2B evidence. For patients with advanced or recurrent gastric cancer who have failed standard treatment, detection of markers such as Claudin18.2, FGFR2, c-MET, and NTRK genes is recommended to find potential therapeutic targets.
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Treatment
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Local Advanced Gastric Cancer：In surgical treatment, for tumors located in the proximal stomach without invading the greater curvature, laparoscopic splenic hilum lymph node dissection on the basis of D2 lymph node dissection does not bring survival benefits. Splenic hilum lymph node dissection is only recommended for mid-upper gastric cancer with primary tumor > 6cm, located on the greater curvature and preoperative stage T3 - 4. In neoadjuvant therapy, the DOS regimen is recommended as a preoperative chemotherapy option. For dMMR patients, immune neoadjuvant therapy is supported by studies such as GERCOR NEONIPIGA; for pMMR patients, relevant research evidence like the DANTE study is added. For unresectable locally advanced gastric cancer, the multidisciplinary diagnosis and treatment model under the MDT framework is emphasized, and research data on conversion therapy with immunotherapy combined with chemoradiotherapy is supplemented.
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Metastatic Gastric Cancer：In first-line targeted therapy, the phase III SPOTLIGHT study results of the Claudin18.2 monoclonal antibody Zolbetuximab combined with chemotherapy for Claudin18.2-positive and HER2-negative advanced gastric cancer are included. In second-line targeted therapy, ramucirumab combined with paclitaxel moves forward as the preferred first-choice recommendation, and data on T-DXd for second-line treatment of advanced gastric cancer is added. In third-line targeted therapy, disitamab vedotin is promoted to grade I recommendation for HER2-positive gastric cancer. In immunotherapy, for first-line treatment, XELOX combined with tislelizumab is a grade I recommendation when TAP ≥ 5%. Meanwhile, SOX combined with Nivolumab is added as a grade III recommendation regardless of PD-L1 expression status. For later-line therapy, relevant evidence of Claudin18.2 CAR-T is supplemented.
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Supplementary Contents：The guidelines put forward detailed screening suggestions for hereditary gastric cancer, helping to identify high-risk groups early and conduct intervention. In addition, an appendix is set up to list drug treatment regimens for different stages of gastric cancer, which provides clear medication references for clinical practice and improves the standardization of treatment.