从IGCC国际视角审视食管胃结合部癌诊治热点问题的变化趋势  

Inspection of the changing trends of hot issues in the diagnosis and treatment of esophago-gastric junction cancer from the international perspective of IGCC

作　　者：赵恩昊[1] 张子臻[1] 朱纯超[1] 曹晖[1] Zhao Enhao;Zhang Zizhen;Zhu Chunchao;Cao Hui(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127

出　　处：《中华消化外科杂志》2024年第10期1277-1283,共7页Chinese Journal of Digestive Surgery

基　　金：上海市科技创新行动计划自然科学基金(23ZR1439400)。

摘　　要：食管胃结合部(EGJ)癌由于其解剖部位的特殊性,在诊断和治疗上存在诸多悬而未决的问题,不仅是各相关学科关注的热点,亦是东、西方学者争议的焦点.2023年第15届国际胃癌大会(IGCC)着重关注EGJ癌,不仅组织各学科专家于会前会即针对外科学、消化内镜和肿瘤学问题进行共识投票,还设置多个分会场就相关问题展开讨论.同时,日本学者提出基于淋巴结清扫价值指数修改的EGJ癌淋巴结清扫流程有望在新版日本胃癌治疗指南中完成更新.EGJ癌的围手术期治疗凸显东、西方在理念和措施上的差异,亚洲学者关注基于DOS治疗方案的新辅助化疗,而欧美学者更希望从CROSS研究的新辅助放化疗中寻找最佳围手术期治疗方案。加人免疫检查点抑制剂后的新辅助治疗方案仅确立在肿瘤退缩和降期上取得优势,尚未在远期生存上凸显获益。不可否认的是,现阶段ECJ癌的诊断与治疗仍在不断探索中前行,未来期待更多新的循证医学证据为微创化、精准化、个体化、综合化临床诊断和治疗提供思路并拓展视野。笔者团队基于对东、西方学者在ECJ癌背景、理念、技术、治疗方案差异及争议的了解和感悟,就EGJ癌诊断与治疗热点问题,结合2023年IGCC以及其他国际会议最新内容进行阐述与剖析,以期为同行带来更多的思考和分析,并更好地指导临床工作。Due to its unique anatomical location,there are many unresolved issues in the diagnosis and treatment of esophagogastric junction(EGJ)cancer,which is not only a hot topic of concern in various related disciplines,but also a controversial topic among scholars in both the East and the West academia.The 15th International Gastric Cancer Congress in 2023 focuses on EGJ cancer,organi-zing consensus voting among experts from various disciplines on surgery,digestive endoscopy,and oncology issues before the conference.Multiple sub venues are also set up to discuss related issues.Meanwhile,Japanese scholars have proposed that the lymph node dissection process for EGJ cancer,modified based on the lymph node dissection therapeutic value index,is expected to be updated in the new version of the Japanese gastric cancer treatment guideline.The perioperative treatment of EGJ cancer highlights the differences in concepts and measures between the East and the West academia.Asian scholars focus on neoadjuvant chemotherapy based on DOS treatment plan,while European and American scholars hope to find the best perioperative treatment plan from the neoadjuvant chemoradiotherapy of CROSS research.However,the new adjuvant therapy regimen with the addition of immune checkpoint inhibitors has only established advantages in tumor regression and decline,and has not yet shown significant benefits in long-term survival.It cannot be denied that the diagnosis and treatment of EGJ cancer are still constantly exploring and advancing.In the future,we look forward to more new evidence-based medicine to provide ideas and expand our horizons for minimally invasive,precise,individualized,and comprehensive clinical diagnosis and treatment.Based on our understanding and insights into the differences and controversies between Eastern and Western scholars in the background,concepts,technologies,and treatment plans of EGJ cancer,the authors elaborate and analyze the hot issues of EGJ cancer diagnosis and treatment,combined with the latest content of the 20

关 键 词：食管胃结合部 国际胃癌大会 淋巴结清扫 围手术期治疗 共识 

分 类 号：R735[医药卫生—肿瘤]