NCCN胃癌治疗指南解读课件.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,NCCN胃癌治疗指南解读,2025/5/19 周一,中国胃癌的发病率和死亡率,世界范围内，中国是胃癌发病率最高的国家之一,总数,:934000,其中,42%,发生在中国,(2019),疾病部位,胃窦仍然是最常见部位,胃食管结合部发病率升高的趋势,多数患者确诊时已为进展期胃癌，且约,70,需要化疗,#Kamangar et al,J Clin Oncol 24:2137-50;2019,上海,(2019-2019):,发病率仍高,:,恶性肿瘤中，男性占第二位，女性占第三位,疾病部位,:,胃窦最常见,为,39.88%,小弯为,12.68%,中国大城市中胃癌的发病率,J sur concepts,practice 2019,vol 13,No 1 24-29,北京,(2019-2019),年度,年龄,2019,2019,2019,M,F,total,M,F,total,M,F,total,1120,0,1,1,0,0,0,0,1,1,21,30,3,2,5,4,4,8,6,9,15,3140,11,12,23,16,13,29,10,21,31,4150,49,16,65,36,29,65,61,41,102,5160,89,27,116,69,41,110,127,52,179,6170,102,18,120,88,39,127,104,36,140,7180,68,19,87,80,23,103,68,24,92,8190,7,0,7,10,2,12,7,6,13,91100,0,0,0,0,0,0,1,0,1,total,329,95,424,303,151,454,384,190,574,50,94/424,(22.2%),102/454(22.5%),149/574,(26.0%),近,3,年来收入院胃癌病例,北京大学临床肿瘤学院,(20192019),AJCC,分期,美国日本 中国,A78%95%93.7%,B58%86%80.2%,34%71%65.7%,A20%59%44.8%,B8%35%23.1%,7%17%10.8%,总计,28%61.4,40%,检测大于,15,个淋巴结,Cancer 2000,88:921-32,中国胃癌患者预后,5,年生存率,进展期胃癌,需全身治疗,中国胃癌发病的特点,J Surg Concepts Pract 2019,Vol.13,No.1,：,24,上海市胃癌发病流行现况,早诊率低,治疗水平差异大,国内高水平的临床研究少，循证医学依据较少,更要求规范治疗行为，统一诊疗标准，特别是综合治疗,东方国家胃癌预后好于西方的可能原因,早期诊断,日韩国家在,40,岁的人群中每2年一次开展全国性胃癌筛查（如,上消化道造影/,胃镜）,治愈切除患者,50%,为,I,期患者,治疗差异,手术,:,D2,切除术是东方国家的标准治疗方式,肿瘤侵袭生物活性弱,胃食管交接癌发病率低,术后随访，1-3年：每3-6月一次，,3-5年：6月一次，以后每年一次,2019,年中国版与,2009,年相比，主要更新内容,GAST-2,初始治疗：身体状况差的,Tis,或,T1a,期患者的初始治疗，新增内镜粘膜下剥离术（,ESD,）作为可选方案之一。,GAST-3,术后治疗新增,S-1,单药辅助治疗，并增加脚注说明仅适用于,D2,根治术后患者，对于根治术后,II,期或,IIIA,期患者可以考虑推荐；对于,IIIB,期，仅适用于年老体弱或体力状况较差的患者。,GAST-5,新增一项随访项目：,“胃癌根治术后患者或,ESD,、,EMR,术后患者进行,HP,检测，如阳性，则给予清除；全胃切除或复发转移性胃癌患者可不常规检测及清除,HP,。”,姑息治疗：更新版本指出，肿瘤复发局限于残胃的患者可以考虑进行手术。,胃癌或胃食管结合部腺癌的全身治疗原则,(GAST-C 2-1),术后化疗：删除术前未行,ECF,方案化疗的患者的术后化疗方案。,新增术后,S-1,辅助化疗，并增加脚注说明仅适用于,D2,根治术后患者，对于根治术后,II,期或,IIIA,期患者可以考虑推荐；对于,IIIB,期，仅适用于年老体弱或体力状况较差的患者。,转移性或局部晚期肿瘤（不推荐进行化放疗时）：顺铂加氟尿嘧啶类方案中，氟尿嘧啶的选择新增替吉奥胶囊，为,2A,类推荐。,胃癌最佳支持治疗原则（,GAST-E 2-1,）,出血：对于胃癌慢性出血的患者，新增化疗作为一项治疗手段。,梗阻：新增胆道梗阻的治疗措施：置入胆管内支架或,PTCD,外引流。,恶性腹水：新增有症状及无症状腹水的治疗方案。,治疗指南更细化，,关注各期患者，,特别是细化最佳支持治疗,手术前后的治疗仍存争议,清除幽门螺旋杆菌感染与早期胃癌术后预防复发的关系,R,A,N,D,O,M,I,Z,E,E,radication,group(272),9 patients,lansoprazole 30mg,Bid,amoxicillin 750mg,Bid,clarithromycin 20mg,Bid,1weeks,C,ontrol,group(272),24 patients,standard care,no,treatment for,HP,544 patients with early gastric cancer,either,newly diagnosed or in post resection follow-up after endoscopic treatment,all with HP infection,.,UMIN1169,临床研究,A,multi-centre,open-label,randomised controlled trial,metachronous,gastric cancer,3-year follow-up,Kazutoshi Fukase,et al;,Lancet,2019;372:39297,对于早期胃癌合并,HP,感染者,EMR,术后三联药物清除治疗可以降低再次胃癌风险！,(HR:0.353,95%CI 0.161-0.775;p=0.009),2009.v.2,2019.v.2,清除幽门螺旋杆菌,只要阳性即应治疗,如果患者有症状，即应治疗,对于根治性胃大部切除术后患者,:,检测,HP,如阳性给予治疗,但对于全胃切除术后患者，是否根除,?,对于不可切除的复发转移性胃癌患者，无需清除,HP,仅对症支持治疗,2019.v.2 NCCN,胃癌指南更新,中国版,2009.v.2,2019.v.2,转移性或局部进展期胃癌,-1,DCF 1,ECF ECF,改良方案,1,伊立替康,+,顺铂,2B,奥沙利铂,+,氟尿嘧啶,(5-FU,或卡培他滨,)2B,伊立替康,+,氟尿嘧啶,(5-FU,或,卡培他滨,)2B,DCF,改良方案,2B,紫杉醇为基础方案,2B,DCF 1,ECF 1,ECF,改良方案,1,伊立替康,+,顺铂,2B,奥沙利铂,+,氟尿嘧啶,(5-FU,或卡培他滨,)2B,伊立替康,+,氟尿嘧啶,(5-FU,或卡培他滨,)2B,DCF,改良方案,2B,紫杉醇为基础方案,2B,曲妥珠单抗,1,2019.v.2 NCCN,胃癌指南更新,美国版,ToGA,试验设计,HER2-positiveadvanced GC(n=584),5-FU or capecitabine,a,+cisplatin,(n=290),R,a,Chosen at investigators discretion GEJ,gastroesophageal junction,5-FU or capecitabine,a,+cisplatin,+trastuzumab,(n=294),Stratification factors,advanced vs metastatic,GC vs GEJ,measurable vs non-measurable,ECOG PS 0-1 vs 2,capecitabine vs 5-FU,Phase III,randomized,open-label,international,multicenter study,1,Bang et al;Abstract 4556,ASCO 2009,3807 patients screened,1,810 HER2-positive(22.1%),来自,24,个 国家,3807,份肿瘤样本,中心实验室检测，,3667,份肿瘤样本被检,810,例,HER2,阳性,总的 阳性率,22.1%,584,例,HER2,阳性患者被随机分为两组进行观察,HER2-positivity rate Europe(23.6%)Asia (23.5%)Taiwan 5.9%(n=34)Australia 32.8%(n=61)China 22.6%,（,n=590,）,HER2,阳性率在欧亚地区是相似的，而在各国家之间有差异,HER2,阳性率与肿瘤部位和类型有关,胃食管结合部腺癌,HER2,阳性率高,肠型胃癌阳性率高，混合型次之，弥漫型最低,Primary end point:OS,Time(months),294,290,277,266,246,223,209,185,173,143,147,117,113,90,90,64,71,47,56,32,43,24,30,16,21,14,13,7,12,6,6,5,4,0,1,0,0,0,No.at risk,11.1,13.8,0.0,0.1,0.2,0.3,0.4,0.5,0.6,0.7,0.8,0.9,1.0,0,2,4,6,8,10,12,14,16,18,20,22,24,26,28,30,32,34,36,Event,FC+,T,FC,Events,167182,HR,0.74,95%CI,0.60,0.91,p value,0.0046,MedianOS,13.811.1,T,trastuzumab,Secondary end point:PFS,0,2,4,6,8,10,12,14,16,18,20,22,24,26,28,30,32,34,Event,294,290,258,238,201,182,141,99,95,62,60,33,41,17,28,7,21,5,13,3,9,3,8,2,6,2,6,1,6,1,4,0,2,0,0,0,5.5,6.7,No.at risk,0.0,0.1,0.2,0.3,0.4,0.5,0.6,0.7,0.8,0.9,1.0,Time(months),FC+,T,FC,Events,226235,HR,0.71,95%CI,0.59,0.85,p value,0.0002,MedianPFS,6.75.5,11,3,OS in,IHC2+/FISH+or IHC3+,(exploratory analysis),1.0,0.8,0.6,0.4,0.2,0.0,36,34,32,30,28,26,24,22,20,18,16,14,12,10,8,6,4,2,0,Time(months),11.8,16.0,FC+,T,FC,Events,120136,HR,0.65,95%CI,0.51,0.83,MedianOS,16.011.8,Event,0.1,0.3,0.5,0.7,0.9,218 198,4,0,5,3,12,4,20,11,228 218,196 170,170 141,142 112,12296,100,75,84,53,65,39,51,28,1,0,0,0,No.at risk,39,20,28,13,Secondary end point:tumor response rate,2.4%,5.4%,32.1%,41.8%,34.5%,47.3%,Intent to treat,ORR=CR+PRCR,complete response;PR,partial response,p=0.0599,p=0.0145,F+C,+trastuzumab,F+C,p=0.0017,Patients(%),CR,PR,ORR,Safety:,与对照组比较无明显增加,hematological AEs,%,F+C,n=290,F+C,+trastuzumabn=294,All,Grade 3/4,All,Grade 3/4,Neutropenia,Febrile neutropenia,Anemia,Thrombocytopenia,57,3,21,11,30,3,10,3,53,5,28,16,27,5,12,5,AE,adverse event,non-hematological AEs,%,Nausea,Vomiting,Fatigue,Diarrhea,Constipation,Asthenia,Stomatitis,Weight decrease,Abdominal pain,63,46,28,28,32,18,15,14,14,7,8,2,4,2,3,2,2,1,67,50,35,37,26,19,24,23,16,7,6,4,9,1,4,1,2,1,Safety:cardiac AEs,a,Measured at baseline and every 12 weeks;MI,myocardial infarction,Cardiac event,n(%),F+C,(n=290),F+C+,trastuzumab(n=294),All,Grade 3/4,All,Grade 3/4,Cardiac AEs,total,18(6),9(3),17(6),4(1),Cardiac failure,2(1),2(1),1(1),1(1),Asymptomatic LVEF drops,a,50%50%and by,10%,2(1.1)2(1.1),14(5.9)11(4.6),Cardiac AEs leading to death,2(1)Cardiac arrest;cardio-respiratory arrest,2(1)Acute MI;angina unstable and cardiac failure,Cardiac AEs related to treatment,2(1),2(1),结 论 和 前 景,ToGA,试验显示,trastuzumab,联合化疗减少了,HER2,阳性胃癌患者,26%,的死亡风险,(HR 0.74),延长,HER2,阳性胃癌患者,中位生存期近,3,月,(11.1 to 13.8 months;p=0.0046),PFS,TTP,ORR,CBR,DoR,得到显著性改善,化疗加用赫赛汀后，患者耐受性良好，所有安全性指标包括心脏不良反应与对照组比较没有显著差异,将成为,Her-2,阳性晚期胃癌的新的治疗选择,2009.v.2,2019.v.2,转移性或局部进展期胃癌,DDP+,氟尿嘧啶,DDP+,卡培他滨,2A,DDP+5FU 2B,口服氟尿嘧啶类,2B,(,老年或体力状况较差者,),DDP+,氟尿嘧啶,DDP+5FU 2B,DDP+,卡培他滨,2A,DDP+,替吉奥胶囊,2A,？,口服,氟尿嘧啶类,(,老年或体力状况较差者,),卡培他滨,2B,？,替吉奥胶囊,2B,？,2019.v.2 NCCN,指南更新,中国版,R,S-1+CDDP,S-1:40-60 mg,bid for 21 days q5wks,CDDP 60 mg/m,2,iv,on day 8,S-1,40,-60 mg,bid(28 days q6wks),主要研究终点,:,OS,次要研究终点,:PFS,TTF,有效率,安全性,纳入病例数,:,298,例,Evidence:,SPIRITS,W Koizumi:The Lancet Oncology 9,215-21,2019,入组患者：不可切除,/,复发性胃癌,OS,不良反应,(3/4,级,),S-1/CDDP(%),S-1(%),中性粒细胞减少,40,11,腹泻,4,3,粘膜炎,1,0,恶心,11,1,厌食,30,6,结 论,S-1,及,S-1+CDDP,两组有效率均较高，,31%,及,54%,S-1,及,S-1+CDDP,两组,中位生存期分别为,11.0,月及,13.0,月,S-1+CDDP,可作为进展期胃癌的标准一线治疗方案,phase III Ramdomized 3-armed study of S-1 monotherapy versus S-1/CDDP(SP)versus 5-FU/CDDP(FP)in patients with advanced gastric cancer(AGC),(SC-101 study),Chinese patients;Ramdomized;Multicenter Comparison study,Peking University School of Oncology,分层因素,:,KPS,转移器官数目,是否胃切除术,R,S-1,S-1:40,mg/m,2,bid(4 weeks on/2 weeks off),S-1+CDDP,CDDP:60 mg/m,2,iv(d8),S-1:40mg/m,2,bid (3 weeks on/2 weeks off,),5-FU+CDDP,CDDP:20mg/m,2,iv(d1-5),5FU:600mg/m,2,civ(d1-5)q4ws.,主要研究终点,:,RR,次要研究终点,:OS,TTF,不良事件,最终分析患者数,:,224,例,Evidence:SC-101,Jin et al.ASCO 2019#4533,入组患者：不可切除,/,复发性胃癌,If failed,can switch to S-1,S-1,SP,FP,RR,24.7%,37.8%,19.2%,SP vs FP p=0.0021,有效率,FP,组,41,例患者进展后转入,S-1,组，又达到,1,4.6%,有效率,(S-1,作为二线化疗,),不良反应,(3/4),S-1,(%),SP,(%),FP,(%),中性粒细胞减少,3.8,17.1,16.2,白细胞减少,1.3,13.2,9.5,贫血,2.5,5.3,5.4,血小板减少,0,6.6,12.2,腹泻,3.8,6.6,0,呕吐,1.3,6.6,0,恶心,0,2.6,5.4,OS,结 论,S-1,及,SP,均安全有效,S-1+,DDP,可作为中国进展期胃癌一线治疗选择,R,A,N,D,O,M,I,Z,E,CS,S-1,25 mg/m,2,PO BID for 21 days,every 4 wks,Cisplatin,75 mg/m,2,IV infusion on day 1,every 4 wks for max 6 cycles,CF,5-FU,1000 mg/m,2,/24 hrs,CI for 5 days,every 4 wks,Cisplatin,100 mg/m,2,IV infusion on day 1,every 4 wks for max 6 cycles,Stratification factors:,Type of disease(locally advanced;1 metastatic site;,2 metastatic sites),Prior adjuvant therapy(y/n),Measurable vs non-measurable disease,Center,Primary Endpoint:,Overall Survival,Secondary Endpoints:,Progression-Free Survival,Safety,Time to Treatment Failure,Overall Response Rate,ClinicalTrials.gov ID:,NCT00400179,FLAGS,Study Design,24 countries/146 centers/1053 patients/non asian trial,Log-rank Test:p=0.1983,Hazard Ratio:0.92(95%CI:0.80,1.05),Median Overall Survival:,CS,:8.6 months,CF,:7.9 months,Overall Survival(FAS),R,A,N,D,O,M,I,Z,E,CS,S-1,25 mg/m,2,PO BID for 21 days,every 4 wks,Cisplatin,75 mg/m,2,IV infusion on day 1,every 4 wks for max 6 cycles,CF,5-FU,1000 mg/m,2,/24 hrs,CI for 5 days,every 4 wks,Cisplatin,100 mg/m,2,IV infusion on day 1,every 4 wks for max 6 cycles,Stratification factors:,Type of disease(locally advanced;1 metastatic site;,2 metastatic sites),Prior adjuvant therapy(y/n),Measurable vs non-measurable disease,Center,Dose?,DDP:75mg vs 100mg,S-1:25mg vs 40mg,TTF?,3.8mo in both arms,Second line Therapy:29.6%vs 33.3%(CS vs CF),Overall Response Rate:29.1%vs 31.9%,Safety,FLAGS?,Study Design!,Subgroup analysis?,Advanced Gastric Cancer,S-1 Mono therapy for patients with poor condition,Patients,Background,Trial,Design,Author,Journal,N,Regimen,RR,TTP,OS,With peritoneal dissemination,Case Report,Osugi et al.,Oncol Rep.2019,18,S-1 80mg/m,2,/day,d1-28,q6w,NA,NA,8.4mo,With poor performance status,PhaseII,Jeung et al.,Br J Cancer.2019,52,S-1 70mg/m,2,/day,d1-14,q3w,12%,2.5mo,7.6mo,With low renal function etc.,Post Marketing Survey,Nagashima et al.,Gastric Cancer.2019,3,801,S-1 80mg/m,2,/day,d1-28,q6w,NA,NA,8.3mo,Advanced Gastric Cancer,S-1 Monotherapy for elderly patients,Trial,Design,Author,Journal,N,Regimen,RR,TTP,OS,PK trial,Fujita et al.,Drug Metab Dispos.2009,10,S-1 80mg/m,2,/day,d1-28,q6w,NA,NA,NA,PhaseII,Koizumi et al.,Cancer Chemother Pharmacol.2009,31,S-1 80mg/m,2,/day,d1-28,q6w,(Adjusted by Creatinine Clearance),21.2%,3.9mo,15.7mo,Randomized,PhaseII,Lee et al.,Br J Cancer.2019,91,Cape 2500mg/m,2,/day,d1-14,q3w,S-1 80mg/m,2,/day,d1-28,q6w,27.2%,28.9%,4.7mo,4.2mo,9.5mo,8.2mo,Retrospective,Study,Seol et al,Jpn J Clin Oncol.2009,72,Cape 2500mg/m,2,/day,d1-14,CDDP 70mg/m,2,d1,q3w,S-1 100-120mg/day,d1-14,CDDP 70mg/m,2,d1,q3w,55.0%,40.6%,5.9mo,5.4mo,10.2mo,9.6mo,Evidence,：,phase III ML17032:XP vs FP,Kang YK Ann Oncol.2009 Jan 20.666-673,Superior ORR with XP vs.FP,Confirmed response%(95%CI),XP(n=160),FP(n=156),p-value,Overall response,41,(33,49),29,(2237),0.030,Superior PFS with XP vs FP,Estimated probability,HR=0.81,(95%CI:0.631.04),Compared to HR upper limit 1.25,p=0.0008,1.0,0.8,0.6,0.4,0.2,0.0,XP(n=139),FP(n=137),Median PFSmonths(95%CI),5.6(4.97.3),5.0(4.26.3),2019.6-2019.8,纳入,141,例患者,(,中位年龄,Age:53.7ys),化疗方案,:,Cape 1000mg/m2 Bid d1-14,DDP 20mg/m2 iv d1-5 q3W,WHO,评价疗效,CTC v2.0,评价不良反应,有效率,CR 3(2.1%),PR 48(34.0%),SD 51(36.2%),PD 39(27.6%),mOS:12.0m,ORR:36.2%,安全性：,3/4 AE 50%,，,8,例腹水完全消失,每周静脉及腹腔给予紫杉醇,联合,S-1,治疗晚期胃癌合并恶性腹水,.,Kitayama J,Ishigami H et al.Oncology.2019;78(1):40-46.Epub 2019 Mar 3.,纳入病例,胃癌伴有腹腔内播散病灶或腹水细胞学阳性患者,方法及结果,方法,:,同前,1,年生存率,78%.,18,例有可测病灶患者中，评价疗效示有效率为,56%,21,例恶性腹水患者中,13,例,(62%),腹水消失。,每周静脉及腹腔给予紫杉醇,联合,S-1,治疗晚期胃癌合并恶性腹水的,II,期临床研究,.,Ishigami H,Kitayama J et al.Ann Oncol.2019 Jan;21(1):67-70.Epub 2009 Jul 15.,目的及 患者,观察疗效及毒副反应,81,例胃肠道恶性肿瘤合并腹水患者,(70,例为胃癌）,方法及结果,腹腔置管、腹腔积液引流、腹腔灌注药物（,FUDR+DDP,），,qw,，,23,次，继之全身化疗（,OXA/DDP+5FU/,卡培他滨）,81,例患者中腹水,CR 16,例（,19.8%,）,PR 18,例,(22.2%),SD 27,例,(33.3%),PD 20,例,(24.7%),，总有效率（,CR+PR,）,42%,；总获益率（,CR+PR+SD,）,75.3%,，中位进展时间（,mTTP,）,4,个月，中位生存期（,mOS,）,5.3,个月，,1,年生存率,16.0%,。,腹涨减轻、食欲增加、,Karnofsky,评分增加,20,分以上者占,67.8%,。,腹腔联合全身化疗治疗胃肠道恶性肿瘤合并腹水,李燕,沈琳。肿瘤研究与临床,。,2009;21(1):52-53.,目的,:,探讨进展期胃癌根治术后行腹腔热灌注化疗（,IPHC,）对于减少术后复发延长生存的意义,Methods,IPHC,组,(92,例,),患者接受腹腔持续热灌注化疗,(MMC 30 mg,，,顺铂,100 mg,加入,2000 ml,蒸馏水中,加热至,42 45,摄氏度,术后行全身化疗,(FAM),对照组,(120,例,),患者仅接受静脉化疗。,持续腹腔热灌注化疗的依据,IPHC,Application of hyperthermic intraoperative intraperitoneal chemotherapy in patients with gastric cancer,Zhang GY et al.,中华胃肠外科杂志,i.2019 Jul;10(4):362-4,.,结果,:,2,年内腹腔内复发率,:,IPHC,组及对照组的复发率分别为,14.1%,及,37.5%(P 0.01).,1-,3-,及,5-,年生存率：,IPHC,组及对照组的生存率分别为,98.9%,68.5%,52.2%,及,95.0%,56.7%,37.5%(3-,及,5-,生存率的比较有统计学差异,p 0.05).,结论,:,IPHC,可以杀灭腹腔内,肿瘤细胞,减少术后腹腔内复发,并改善胃癌根治术后的预后。,持续腹腔热灌注化疗的依据,IPHC,Application of hyperthermic intraoperative intraperitoneal chemotherapy in patients with gastric cancer,Zhang GY et al.,中华胃肠外科杂志,i.2019 Jul;10(4):362-4,.,小剂量,CDDP,腹腔内化学治疗胃癌腹腔转移患者,Ninomiya M et al,Gan To Kagaku Ryoho.2019 Oct;31(11):1717-9.,腹腔内灌注,CDDP,治疗胃癌腹腔内转移的疗效和安全性,.,Bamba T et al,Gan To Kagaku Ryoho.2019 Oct;32(11):1695-7.,author,，,year,cases,Systemic chemo,Systemic+,IP chemo,Response rate,(%),Bone Marrow toxicity,Nausea or vomiting,QOL,Su et al.2019,54 vs 49,FLEP,FL+,EP,64.8 VS 44.9,same,same,Gu et al.2019,30 vs 26,ELFP,ELF+P,60.0 VS,42.3,Low in IPC group,Chen et al.2019,35 vs 28,ELFP,ELF+P,54.3 VS 28.6,Low in IPC group,Better in IPC,Wang et al.2019,21 vs 27,ECF,EF+P,66.67 vs 29.63,same,same,Yang et al.2019,33 vs 30,ELFP,ELF+P,85.2 vs 58.8,（,1y survival,）,Low in IPC group,Low in IPC group,Better in IPC,苏炳光等，肿瘤防治杂志，,2019,；顾汉刚等，中国肿瘤临床，,2019,；陈国荣等，肿瘤研究与临床，,2019,；,王跃辉等，中国肿瘤临床，,2019,；杨家梅等，中国误诊学杂志，,2019,中国发表的腹腔化疗联合全身化疗,(IPC),的,随机对照临床研究,最佳支持治疗,腹水,恶性腹水,无症状，参照胃癌的系统化疗,GAST-C,有症状,腹水引流,腹腔化疗联合全身化疗,-5FU,顺铂,紫杉醇,MMC 2A,腹腔持续热灌注化疗，,IPCH 2B,研究水平较低，缺乏大样本随机对照临床试验,中国临床研究资料较多，但多为回顾性研究,研究显示对有症状的腹腔积液，腹腔化疗可控制腹水、改善患者生活质量,胃癌治疗指南中国版未来的发展,优化方案，进一步延长患者生存期,术前放化疗的改变？,新分期对预后及术后治疗选择的影响,术后辅助治疗的选择？,恶性腹水腹腔灌注及热灌注的治疗,国内高级别循证医学证据？,谢谢！,