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关于可切除胃癌的定义还未获得全球统一认可。在第16届国际胃癌大会（IGCC）上，卢布林医科大学的Wojciech Polkowski教授汇报了胃癌可切除性标准国际(ICRGC)项目的初步成果，会后，Polkowski教授接受了我们的独家专访。

肿瘤瞭望消化时讯：ICRGC 项目旨在建立胃癌可切除性的全球标准。请问我们为什么迫切需要弥合各地区的差异并建立国际共识？

Polkowski教授：自去年在意大利锡耶纳举行的国际胃癌协会欧洲分会会议以来，关于可切除胃癌的定义还未获得普遍共识。此前，不同指南（如NCCN指南和中国指南）对可切除性的标准存在差异，这些定义未获得全球统一认可。文献中亦存在从技术以及外科角度界定可切除与非可切除胃癌的学术探讨。如今随着这些定义的确立，各大洲（亚洲、欧洲、北美和南美）的临床实践仍存在差异。例如，在远东地区（包括中国）胃癌发病率较高，进展期胃癌患者比例巨大，这种情况与我的国家波兰有一定相似性。

在21世纪，传统化疗联合新型系统治疗为患者提供了可能，这些疗法虽疗效显著但成本高昂。在具备经济条件的国家，这类现代治疗方案可作为根治性切除术后的辅助治疗。因此，明确定义胃癌可切除性并获得全球各学术组织的普遍认可至关重要。

Dr Polkowski: Since last year’s European Chapter of the International Gastric Cancer Association Meeting in Siena, Italy, there isn’t a general acceptance of the definition of what resectable gastric cancer is. There were some recommendations, such as in the American NCCN Guidelines and the Chinese Guidelines, for example, that differed in terms of definition. These were not universally accepted, and there are moves to define what is resectable or not in the literature, from a technical and oncological point of view. Now these definitions have been settled, the situation in the different continents (in Asia, Europe, North America and South America) differs. There are different situations for patients with gastric cancer, for example, there is a higher prevalence of malignancy in countries in the Far East, including China. The percentage of patients with advanced gastric and metastatic cancer is huge. To some extent, the prevalence is similar to the situation where I come from in Poland. In the 21st century, there is a possibility for new systemic treatments which aid to conventional chemotherapy an immunotherapy. These new regimens are very effective, but very expensive as well. In those countries where patients are able to be treated with this modern expensive treatment, it can be applied after resection, which is the principal method of treatment. Therefore, it is important to clearly define the resectability of gastric cancer, and that should be generally accepted by all Societies across the world.

肿瘤瞭望消化时讯：如果 ICRGC 标准被广泛采用，它们将如何重塑我们的临床决策？

Polkowski教授：必须指出，这项工作尚处于起步阶段——标准制定尚未完成。本次阿姆斯特丹会议上我的报告仅代表我们研究的初期成果。预计未来1~2年内，通过召开多场共识会议，这项标准化工作就能完成。当前我们正处于标准提案阶段，若这些提议获得会议专家广泛认可，将进入全球评估实施阶段。该进程需要全球外科医生的共同参与。目前我们已与约50位外科专家建立合作，但仍有多个地区尚未覆盖。我非常期待中国外科专家能加入本项目。

Dr Polkowski: I should say we are in the beginning of that work – the criteria are not yet complete. At this conference in Amsterdam, my presentation reflects the beginning of our work. Maybe in a year or two, this process will be finished through several consensus meetings. Just right now, we are in the process of proposing all the criteria. If these propositions are widely accepted by experts at these meetings, then they will be presented for evaluation for implementation. This needs to be done across all continents. It will require surgeons to contribute from all over the world. So far, we have cooperated with a group of about fifty surgeons, but there are regions of the world that are not represented. I would be very happy if Chinese surgeons were to join our project.

研究介绍

01.1.2-胃癌可切除性标准国际(ICRGC)项目:迈向全球共识。

背景:

晚期胃癌(GC)的可切除性对手术结果和总体生存率有显著影响。缺乏可切除性的通用定义突显了制定标准化指标的必要性。国际胃癌可切除性共识(ICRGC)项目旨在通过整合技术和肿瘤学考量因素建立全球公认的指南。

方法：

为了启动共识过程，ICRGC问卷在2024年10月于锡耶纳举行的欧洲胃癌协会(EGCA)会议上分发。该问卷寻求专家意见，以区分技术和肿瘤学可切除性、多脏器切除和扩大切除的适应症以及术前系统治疗的作用。对60名受访者的数据进行分析，以确定全球实践中的共识和分歧领域。

结果：

实现R0切除成为手术成功的基石。79%的参与者区分了技术性和肿瘤学上的可切除性，强调了其对临床决策的影响。80%的人认为伴肠系膜根部浸润的GC无法切除，75%的人认为血管包绕和广泛浸润是病灶无法切除的原因。然而，在多脏器切除方法、寡转移性疾病的处理以及新辅助治疗的使用方面仍存在差异，这反映了机构专业知识和资源的可及性。

结论：

ICRGC项目的主要目的是统一晚期GC的可切除标准，通过综合全球专家的意见，旨在创建循证指南以改善决策制定、患者结果和国际合作。未来的方向包括使用德尔菲共识方法来完善这些标准。

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