The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2021

Abstract

There exist differences in the epidemiological characteristics, clinicopathological features, tumor biological characteristics, treatment patterns, and drug selections between gastric cancer patients from the Eastern and Western countries. The Chinese Society of Clinical Oncology (CSCO) has organized a panel of senior experts specializing in all sub‐specialties of gastric cancer to compile a clinical guideline for the diagnosis and treatment of gastric cancer since 2016 and renews it annually. Taking into account regional differences, giving full consideration to the accessibility of diagnosis and treatment resources, these experts have conducted expert consensus judgment on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes in China. The 2021 CSCO Clinical Practice Guidelines for Gastric Cancer covers the diagnosis, treatment, follow‐up, and screening of gastric cancer. Based on the 2020 version of the CSCO Chinese Gastric Cancer guidelines, this updated guideline integrates the results of major clinical studies from China and overseas for the past year, focused on the inclusion of research data from the Chinese population for more personalized and clinically relevant recommendations. For the comprehensive treatment of non‐metastatic gastric cancer, attentions were paid to neoadjuvant treatment. The value of perioperative chemotherapy is gradually becoming clearer and its recommendation level has been updated. For the comprehensive treatment of metastatic gastric cancer, recommendations for immunotherapy were included, and immune checkpoint inhibitors from third‐line to the first‐line of treatment for different patient groups with detailed notes are provided.

Risk Assessment and Preventive Treatment for Peritoneal Recurrence Following Radical Resection for Gastric Cancer

“…After diagnosis and staging by routine endoscopy examination, endoscopic biopsy, and contrast-enhanced CT, laparoscopy with/without peritoneal lavage cytology is recommended for patients with stage I B or higher GC or with suspected peritoneal metastasis ( 32 , 34 , 35 ). For GC patients with positive peritoneal cytology or macroscopic peritoneal metastases, it is necessary to change the treatment strategy instead of direct radical operation.…”

Peripheral Lymphocyte Subsets Absolute Counts as Feasible Clinical Markers for Predicting Surgical Outcome in Gastric Cancer Patients After Laparoscopic D2 Gastrectomy: A Prospective Cohort Study

“…To overcome these hurdles, prospective trials with a larger sample size and more clinical-pathological measurements are needed to validate the findings of our study. According to clinical guidelines for the diagnosis and treatment of gastric cancer from The Chinese Society of Clinical Oncology (CSCO), 54 stage II and III gastric cancer patients suitable for surgery were recommended for D2 gastrectomy plus adjuvant chemotherapy (Evidence 1A). However, preoperative chemotherapy might affect the count of lymphocyte subsets, but it would improve long-term outcome in locally advanced gastric cancer.…”

Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved

“…Lymph node metastasis is always the key indicator for AC management. For patients who received D2 lymphadenectomy, achieving R0 resection and pN0 diagnosis, pT1-3N0M0 are exempt from the AC according to the 5th JGCA guideline ( 26 ), while in the Chinese Society of Clinical Oncology (CSCO) guideline, AC was only recommended for pT3-4N0M0 ( 5 ). The newly introduced concept of ypTNM stage has complicated the management for LAGC patients because the “yp” concept has regarded itself as the intermediate product after the NAC treatment ( 27 ).…”

“…While there could be some extra benefit for PEC comparing to AC, the regimens and the recommended length in these two modalities are almost the same according to various guidelines (5)(6)(7). Among limited selections, 5-fluorouracil (5-Fu) and platinum are the cornerstones of most first-line chemotherapy regimens for gastric cancer (GC).…”