201505_我国胃癌治疗现状ver2

ChallengeforSurgeonsinCHINACurrentsituationandfuturetrendsJiafuJiMD,PhD,FACSTumorburdenChina:454,014/yearGlobal:1,034,124/year43.9%404996454014522852606124700048777253325166365235422471498551590547666906201220152020202520302035IncidenceMortalityFerlayJ,SoerjomataramI,ErvikM,DikshitR,EserS,MathersC,RebeloM,ParkinDM,FormanD,Bray,F.GLOBOCAN2012v1.0,CancerIncidenceandMortalityWorldwide:IARCCancerBaseNo.11[Internet].Lyon,France:InternationalAgencyforResearchonCancer;2013.Availablefrom:韩启德关于医学技术发展的价值思考HighExpenseGreatCostPriceoftreatment：Surgery+Chemo≈160k/人=23years’incomeforarurallabor「CatastrophicExpenditure」Estimateannualeconomicloss￥209BillionChinesefeatureCSCO.GastricCancerSurvey.2011EGC10.8%MGC31.2%LocallyAdvancedGC58.0%LessEGC,MoreLAGCD2gastrectomyMDTLaparoscopyMorepositivestrategyStandardprocedureWellacceptedWidelypromotedPathologicallyconfirmedgastriccancerEndoscopicultrasoundEnhancedCTEMR/ESD/Laparoscopicassistedradicalgastrectomy/StandardradicalgastrectomyDiagnosticLaparoscopyExperimental/Palliative/OptimalsupportivecareSurgery+perioperativeadjuvanttherapyT1N0T2+\N+TanyNanyM1M020.5%77.6%1.8%DatafromPKUCH,2013.8-2014.9TreatmentalgorithminPKUCHMDT-DigitalmanagementSurgeryforEGCTherapeuticoptionsofEGCTheTrendsofEMR/ESDinBeijingCancerHospital,2011-2013Data:PKUCH,DepartmentofEndoscopy020406080100120'11'12'13AnnualGrowth:22%Video:PKUCH,DepartmentofEndoscopyExpandingboundaryofESD•TherenovationoftreatmentstrategydemandsforbetterAccuracyandComprehensivenessinclinicalstagingDatafromPKUCH,2013.8-2014.9pT1——88.7%pN+——8.2%NewchallengeCurrenttrends:SLNNavigationDyethroughserosaJCOG0302missedpN+46.4%1.Te99:1daybeforesurgery2.Dye:duringsurgeryEndoscopicDual-tracerSN(-)/non-SN(+)→1%Accuracy:99%*“SentinelLymphNodeBiopsy”[mesh]Node&“StomachNeoplasms”[mesh]SearchinPubMed[类别名…[类别名称][百…[类别名称][百…Others23%SurgeryforLAGCR0rateinChina:52.2%.5-yearoverallsurvival:36.8%.IaIbIIIIIaIIIbIVMSKCC+DGCT(US+GER)95%83%55%38%14%14%JGCA(JAP)92%85%73%51%33%16%SNUH(KOR)93%84%67%50%31%13%PKUCH(CHN)97%84%68%46%29%8%0%10%20%30%40%50%60%70%80%90%100%5yrsOvrallSurvivalJohanL.Dikkenetal.AnnSurg2012;May23.LeeHKetal.BrJSurg2001;88:1408-1412.Yohetal.GastricCancer2011;14:301-316.JiJFetal.ChinJPracSurg2011;8:38-43.JiJF.ChinJCancerRes.2010;22(3):167-175Samemethod,Differentprognosis•AccordancebetweencStageandpStage:53.4%UnderSfitOverSCount2204%ofTotal3.4%3.4%0.0%6.9%Count514322%ofTotal8.6%24.1%5.2%37.9%Count052732%ofTotal0.0%8.6%46.6%55.2%Count7213058%ofTotal12.1%36.2%51.7%100.0%TotalEUSTotalCTUnderStagingfitOverStagingDatafromPKUCH,ClinicalTrialLimitation:clinicalstagingpT1apT2pT3pT4apT4bCount101204%withincT25.0%0.0%25.0%50.0%0.0%100.0%Count112319246%withincT2.2%2.2%50.0%41.3%4.3%100.0%Count000213%withincT0.0%0.0%0.0%66.7%33.3%100.0%Count212423353%withincT3.8%1.9%45.3%43.4%5.7%100.0%TotalcT*pTCrosstabulationpTTotalcTT3T4aT4bpT1apT2pT3pT4apT4bCount2064012%withinuT16.7%0.0%50.0%33.3%0.0%100.0%Count012118343%withinuT0.0%2.3%48.8%41.9%7.0%100.0%Count000101%withinuT0.0%0.0%0.0%100.0%0.0%100.0%Count212723356%withinuT3.6%1.8%48.2%41.1%5.4%100.0%TotaluT*pTCrosstabulationpTTotaluTuT3uT4auT4bDatafromPKUCH,ClinicalTrialLimitation:clinicalstagingReversedSurvivalCTEUSLimitation:clinicalstagingPathologyLimitation:clinicalstagingPositiveRateincM0Patients15.7%（113/718）Staginglaparoscopy+CytologyPhoto&Data：PKUCH,2011.8-2014.92013.8-2014.913.2%（62/469）2011.8-2013.820.5%（51/249）Data：PKUCH,2011.8-2014.97.3%MDTimprovestagingabilityControversiesoftheindicationOurOngoingstudy•cT2+M0,GC•Noevidenceofperitonealdisseminationpreoperativelyn=450StagingLaparoscopyClinicalCharacterrecordedinprospectivedatabase.laparoscopicstagingforLAGCinChinesePatientCenterRecruitmentPKUCH65YKZL10CYYY2BDYY2InadequateclinicalstagingLowaccuracyforclinicalstagingInappropriategastrectomyforstageIVInconformityofsurgeryqualityLackofspecificatetrainingLackofaccesssystem2000+capablehospitaltotreatGCThreatforqualitycontrollivesatellitebroadcastUpto6,000traineeData:CGCA,2008-2014Photo:9thNGCAC,2014TrainingtourforD2surgeryDatafromPKUCH,2013.8-2014.9NACT15.1%NARCT2.1%OP/CT54.8%LAP/CT13.2%TreatmentStrategySurgerymethodCurrenttherapyofLAGCData:JiafuJietal,ChinJCancerRes.2010;Takashietal,CancerJ.2007.DistantLocalPeritonealPartI:Recur.pattern→strategyRXELOXSOXSOX→S-1SOXDesign:RCT,PhaseIIIPatient:LAGC(cT4b/N+M0orcT4aN+M0)Samplesize:1059.500until2015.4(47.2%)PrimaryOutcome:3-yearDFSSecondaryOutcome:5-yearOS•Center•LaurentypeOPERATION(n=353)(n=353)(n=353)19个省市48家单位……Data:RESOLVETrial,2014Ongoing:RESOLVE(NCT01534546)LiZY，JiJF*,etal.JournalofSurgicalOncolgy2011,DOI10.1002/jso.23009pCR:12.1%4(12.1%)UnsatisfiedresponseNACRT45Gy/25fNACRTforEGJ:experienceRandomizationRadiotherapyGTV50GyCTV45GyChemotherapyOXA40mg/m2/d1,8,15,22,29S-130mg/m2bidd1-d5/wnoSurgeryTotalGastrectomyD2lymphadenectomyChemotherapyOXA130mg/m2/d1Q3wS-140-60mgbidd1-d14Q3w6-8cyclesGroupA(neoCRT)n=128GroupB(surgry)n=128ResponseevaluationPreoperativechemoradio