Prof. Carlos García

胃癌本身具有高度的疾病异质性，我们首先要厘清一个核心问题：东亚与拉丁美洲胃癌患者，在肿瘤生物学特征上存在哪些差异，这是所有讨论的前提。

其次是胃癌筛查策略。筛查是检出早期胃癌非常有效的手段，但这套方案在我们国家落地推行面临诸多现实阻碍。检测幽门螺杆菌感染是另一条可行的防控路径，我们需要去评估不同策略在胃癌防治当中的价值。日本、韩国所推行的大规模胃镜筛查是成熟方案，但并不适合直接照搬。在拉丁美洲，我认为更贴合本土情况的方案是：先开展幽门螺杆菌感染筛查，对阳性高危人群再进一步做内镜检查明确诊断。我们知道，不少南美国家同样面临沉重的胃癌疾病负担。

Japan, Korea, and China have generated a large amount of evidence in gastric cancer. However, Latin America differs from East Asia in disease characteristics, early detection, and healthcare resources. Which experiences from East Asia have had the greatest impact on gastric cancer practice in Latin America? And which questions need to be answered by research from Latin America itself?

Prof. Carlos García ：

I think gastric cancer is a highly heterogeneous disease. The first key question is what are the differences in tumor biology between East Asian patients and Latin American patients. This question needs to be clarified first.

Second, let's talk about screening programs. Screening programs represent an effective method to identify early-stage gastric cancer, yet its implementation is very challenging in our countries. Detecting Helicobacter pylori infection serves as an alternative approach. How can different strategies contribute to gastric cancer control?One approach is the screening programme adopted in Japan and South Korea. Nevertheless, for Latin America, I believe the optimal strategy is to test for Helicobacter pylori infection, and confirm positive patients by endoscopy. We know that several South-American countries also suffer from a high burden of gastric cancer.

Prof. Carlos García

在日本与韩国，筛查是胃癌临床诊断体系里至关重要的一环。智利多年前也曾开展过筛查相关实践，但受限于经济因素，政府最终决定不再继续推行该筛查项目。

就当下而言，我个人认为检测幽门螺杆菌感染、评估患者胃黏膜状态有着十分重要的意义。我们可以借助OLGA/OLGIM黏膜分期系统，筛选出胃癌发生的高危人群。这一思路可以借鉴大肠杆菌O157:H7感染的临床处置逻辑：先筛检出感染者，再运用黏膜分期体系，进一步评估这类人群的胃黏膜病变特征。

Some Latin America countries also have a high burden of gastric cancer, but limited healthcare resources and access to endoscopy make it difficult to directly adopt the screening models used in Japan and Korea. In this setting, what do you think is the most practical way to improve early detection? Could risk stratification help identify the people who would benefit most from endoscopic screening?

Prof. Carlos García ：

In Japan and Korea, screening is the most critical component for gastric cancer diagnosis. Chile had relevant screening experience many years ago. However, the government decided to discontinue the screening programme, mainly for economic reasons.

Nowadays, I hold that it is critical to detect Helicobacter pylori infection and evaluate gastric mucosal alterations. We can apply the OLGA / OLGIM mucosal classification system to identify patients at risk of progressing to gastric cancer. We may draw an analogy with E. coli O157:H7 infection: first, identify patients infected with E. coli O157:H7; second, evaluate the main mucosal characteristics of these patients using mucosal classification systems.

肿瘤瞭望消化时讯：您将担任下一届IGCC主席，IGCC 2027以“Gastric Cancer in the Real World”为主题。为什么大会特别选择“Real World”作为主题？在您看来，目前全球胃癌研究与真实临床实践之间最需要跨越的差距是什么？对于中国胃癌研究者，您最期待他们在下一届IGCC带来哪些研究和经验？

Prof. Carlos García

放眼全球，胃癌的诊疗存在显著的发展不均衡问题，不同国家之间的经济差距是造成这一现象的首要原因。

举例而言，欧洲具备充沛的研究资源，用于探索单药等创新治疗方案；中国同样在新型单药治疗领域投入了大量研究力量，但研究的实际情况和欧洲并不完全相同。拉丁美洲会参考欧洲、中国、日本产出的各类研究证据，但我们所面对的患者群体、本土临床环境都存在差异，这种诊疗不均衡的现状客观存在。

我认为国际胃癌协会（IGCA）最重要的使命之一，就是减轻、逐步缩小胃癌患者在治疗上所面临的这种不平等。比如说，并不是所有患者都适合接受单药治疗；仅仅依据TNM分期，也无法判断哪些患者应当使用单药。是否选用单药治疗，很大程度上取决于肿瘤本身的生物学特征。因此我期待IGCA能够建立更为完善的胃癌患者分型体系，以此辅助优化这类临床治疗决策。

As President-elect of IGCC 2027, you have chosen “Gastric Cancer in the Real World” as the theme of the next congress. Why did you choose “Real World” as the theme? What is the most important gap between gastric cancer research and real-world clinical practice today? And what would you most like to see Chinese researchers bring to IGCC 2027?

Prof. Carlos García ：

Globally, substantial inequalities exist in the diagnosis and treatment of gastric cancer, primarily economic inequalities across different countries.

For instance, Europe possesses abundant resources for research on novel advances such as monotherapy and other agents. China also invests substantial resources into exploring new monotherapies, yet its research landscape differs from that of Europe. Latin America incorporates research findings from Europe, China and Japan. However, our patient populations and clinical contexts are distinct, and inequalities persist.I believe one of IGCA's key roles is to mitigate and reduce inequalities in gastric cancer treatment.For example, not all patients require monotherapy. Monotherapy should not be prescribed merely based on TNM classification. The indication for monotherapy may be associated with the biological characteristics of the tumour.I think IGCA can facilitate better clinical decision-making by developing improved classification tools for gastric-cancer patients.

· 专家介绍 ·

Carlos García Carrasco

Carlos García Carrasco 教授

主任医师

智利大学外科学副教授

智利大学中心校区外科主任

智利圣地亚哥圣博尔哈 - 阿利亚兰医院消化外科团队主任

第17届国际胃癌大会（IGCC 2027，智利圣地亚哥）大会主席、组委会主席

智利外科学会前任主席

Carlos García Carrasco教授为消化外科与肿瘤外科医师，临床与学术研究方向以胃癌为主。他于智利大学完成普通外科专科培训，并在日本东京都驹込医院接受消化外科进阶研修