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

      research-article
      Author(s): 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 1 , 12 , 13 , 14 , 1 , 15 , 16 , 17 , 18 , 10 , 19 , 20 , 21 , 22 , 14 , 23 , 3 , 24 , 25 , 26 , 2 , 27 , 1 ,
      Publication date (Electronic):
      Journal: Cancer Communications
      Publisher: John Wiley and Sons Inc.
      Keywords: adjuvant, chemotherapy, Chinese Society of Clinical Oncology (CSCO), diagnosis, gastric cancer, immunotherapy, neoadjuvant, radiotherapy, surgery, targeted therapy

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          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.

          Abstract

          The Chinese Society of Clinical Oncology (CSCO) organized a panel of senior experts specializing in all sub‐specialties of gastric cancer to compile the clinical guideline for gastric cancer in 2016 and then renewed it every year. The 2021 CSCO Clinical Practice Guidelines for gastric cancer covered the diagnosis, treatment, follow‐up and screening.

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          Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

          Hyuna Sung, Jacques Ferlay, Rebecca Siegel … (2021)
          This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.
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            New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).

            E A Eisenhauer, P Therasse, J. Bogaerts … (2009)
            Assessment of the change in tumour burden is an important feature of the clinical evaluation of cancer therapeutics: both tumour shrinkage (objective response) and disease progression are useful endpoints in clinical trials. Since RECIST was published in 2000, many investigators, cooperative groups, industry and government authorities have adopted these criteria in the assessment of treatment outcomes. However, a number of questions and issues have arisen which have led to the development of a revised RECIST guideline (version 1.1). Evidence for changes, summarised in separate papers in this special issue, has come from assessment of a large data warehouse (>6500 patients), simulation studies and literature reviews. HIGHLIGHTS OF REVISED RECIST 1.1: Major changes include: Number of lesions to be assessed: based on evidence from numerous trial databases merged into a data warehouse for analysis purposes, the number of lesions required to assess tumour burden for response determination has been reduced from a maximum of 10 to a maximum of five total (and from five to two per organ, maximum). Assessment of pathological lymph nodes is now incorporated: nodes with a short axis of 15 mm are considered measurable and assessable as target lesions. The short axis measurement should be included in the sum of lesions in calculation of tumour response. Nodes that shrink to <10mm short axis are considered normal. Confirmation of response is required for trials with response primary endpoint but is no longer required in randomised studies since the control arm serves as appropriate means of interpretation of data. Disease progression is clarified in several aspects: in addition to the previous definition of progression in target disease of 20% increase in sum, a 5mm absolute increase is now required as well to guard against over calling PD when the total sum is very small. Furthermore, there is guidance offered on what constitutes 'unequivocal progression' of non-measurable/non-target disease, a source of confusion in the original RECIST guideline. Finally, a section on detection of new lesions, including the interpretation of FDG-PET scan assessment is included. Imaging guidance: the revised RECIST includes a new imaging appendix with updated recommendations on the optimal anatomical assessment of lesions. A key question considered by the RECIST Working Group in developing RECIST 1.1 was whether it was appropriate to move from anatomic unidimensional assessment of tumour burden to either volumetric anatomical assessment or to functional assessment with PET or MRI. It was concluded that, at present, there is not sufficient standardisation or evidence to abandon anatomical assessment of tumour burden. The only exception to this is in the use of FDG-PET imaging as an adjunct to determination of progression. As is detailed in the final paper in this special issue, the use of these promising newer approaches requires appropriate clinical validation studies.
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              Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade

              Dung Le, Jennifer N. Durham, Kellie N Smith … (2017)
              The genomes of cancers deficient in mismatch repair contain exceptionally high numbers of somatic mutations. In a proof-of-concept study, we previously showed that colorectal cancers with mismatch repair deficiency were sensitive to immune checkpoint blockade with antibodies to programmed death receptor-1 (PD-1). We have now expanded this study to evaluate the efficacy of PD-1 blockade in patients with advanced mismatch repair-deficient cancers across 12 different tumor types. Objective radiographic responses were observed in 53% of patients, and complete responses were achieved in 21% of patients. Responses were durable, with median progression-free survival and overall survival still not reached. Functional analysis in a responding patient demonstrated rapid in vivo expansion of neoantigen-specific T cell clones that were reactive to mutant neopeptides found in the tumor. These data support the hypothesis that the large proportion of mutant neoantigens in mismatch repair-deficient cancers make them sensitive to immune checkpoint blockade, regardless of the cancers' tissue of origin.
              Article 0 comments Cited 1947 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Rui‐Hua Xu: xurh@sysucc.org.cn
                Journal
                Journal ID (nlm-ta): Cancer Commun (Lond)
                Journal ID (iso-abbrev): Cancer Commun (Lond)
                Journal ID (doi): 10.1002/(ISSN)2523-3548
                Journal ID (publisher-id): CAC2
                Title: Cancer Communications
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2523-3548
                Publication date (Electronic): 01 July 2021
                Publication date Collection: August 2021
                Volume: 41
                Issue: 8 ( doiID: 10.1002/cac2.v41.8 )
                Pages: 747-795
                Affiliations
                [ 1 ] Department of Medical Oncology State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Sun Yat‐sen University Cancer Center Guangzhou Guangdong 510060 P. R. China
                [ 2 ] Department of Gastrointestinal Oncology Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education) Peking University Cancer Hospital and Institute Beijing 100142 P. R. China
                [ 3 ] Department of Gastric Surgery State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Sun Yat‐sen University Cancer Center Guangzhou Guangdong 510060 P. R. China
                [ 4 ] Department of Radiology Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education) Peking University Cancer Hospital and Institute Beijing 100142 P. R. China
                [ 5 ] Department of Medical Oncology The First Hospital of China Medical University Shenyang Liaoning 110001 P. R. China
                [ 6 ] Department of Medical Oncology Zhejiang Cancer Hospital Hangzhou Zhejiang 310006 P. R. China
                [ 7 ] Department of Medical Oncology Ruijin Hospital Shanghai Jiaotong University School of Medicine Shanghai 200025 P. R. China
                [ 8 ] Department of Surgical Oncology The Fourth Affiliated Hospital of Harbin Medical University Harbin Heilongjiang 150001 P. R. China
                [ 9 ] Department of Medical Oncology Fujian Cancer Hospital Fuzhou Fujian 350000 P. R. China
                [ 10 ] Department of Medical Oncology Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology Wuhan Hubei 430030 P. R. China
                [ 11 ] Cancer Center of The First Hospital of Jilin University Changchun Jilin 130021 P. R. China
                [ 12 ] Department of Pathology State Key Laboratory of Oncology in South China Collaborative Innovation Center of Cancer Medicine Sun Yat‐sen University Cancer Center Guangzhou Guangdong 510060 P. R. China
                [ 13 ] Department of Endoscopy Center Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education) Peking University Cancer Hospital and Institute Beijing 100142 P. R. China
                [ 14 ] Department of General Surgery Nanfang Hospital Southern Medical University Guangzhou Guangdong 510515 P. R. China
                [ 15 ] Department of Oncology National Cancer Center National Clinical Research Center for Cancer Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100021 P. R. China
                [ 16 ] Department of Radiotherapy State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Sun Yat‐sen University Cancer Center Guangzhou Guangdong 510060 P. R. China
                [ 17 ] Department of Medical Oncology Zhongshan Hospital Affiliated to Fudan University Shanghai 200032 P. R. China
                [ 18 ] Department of Abdominal Oncology West China Hospital of Sichuan University Chengdu Sichuan 610041 P. R. China
                [ 19 ] Department of Radiology Zhongshan Hospital Fudan University Shanghai 200032 P. R. China
                [ 20 ] Pathology Laboratory of Gastrointestinal Tumor The First Hospital of China Medical University Shenyang Liaoning 110001 P. R. China
                [ 21 ] Department of Pathology Zhongshan Hospital Affiliated to Shanghai Fudan University Shanghai 200032 P. R. China
                [ 22 ] Department of Gastrointestinal Oncology Surgery The First Hospital of China Medical University Shenyang Liaoning 110001 P. R. China
                [ 23 ] Department of Gastrointestinal Surgery Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education) Peking University Cancer Hospital and Institute Beijing 100142 P. R. China
                [ 24 ] Department of Gastric Surgery Tianjin Medical University Cancer Institute & Hospital Tianjin 300060 P. R. China
                [ 25 ] Department of Gastrointestinal Medical Oncology Cancer Hospital of Harbin Medical University Harbin Heilongjiang 150081 P. R. China
                [ 26 ] Department of Radiation Oncology Shenzhen Center Cancer Hospital of Chinese Academy of Medical Sciences Shenzhen 518000 P. R. China
                [ 27 ] Department of Oncology East Hospital Affiliated to Shanghai Tongji University Shanghai 200120 P. R. China
                Author notes
                [*] [* ] Correspondence

                Rui‐Hua Xu, Department of Medical Oncology, Sun Yat‐sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, Guangdong, P. R. China.

                Email: xurh@ 123456sysucc.org.cn

                [#]

                Fenghua Wang and Xiaotian Zhang are the first co‐authors.

                [##]

                Jin Li and Lin Shen are the co‐corresponding authors.

                Article
                Publisher ID: CAC212193
                DOI: 10.1002/cac2.12193
                PMC ID: 8360643
                PubMed ID: 34197702
                SO-VID: 44e9377c-adb0-413e-9109-02216a228a4b
                Copyright © © 2021 The Authors. Cancer Communications published by John Wiley & Sons Australia, Ltd. on behalf of Sun Yat‐sen University Cancer Center
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date revision received : 21 June 2021
                Date received : 05 June 2021
                Date accepted : 23 June 2021
                Page count
                Figures: 0, Tables: 23, Pages: 49, Words: 30846
                Categories
                Subject: Guidelines and Consensus
                Subject: Guidelines and Consensus
                Custom metadata
                source-schema-version-number 2.0
                cover-date August 2021
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.5 mode:remove_FC converted:12.08.2021

                Keywords: adjuvant,chemotherapy,chinese society of clinical oncology (csco),diagnosis,gastric cancer,immunotherapy,neoadjuvant,radiotherapy,surgery,targeted therapy
                Data availability:
                Keywords: adjuvant, chemotherapy, chinese society of clinical oncology (csco), diagnosis, gastric cancer, immunotherapy, neoadjuvant, radiotherapy, surgery, targeted therapy

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