Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.

• This ESMO Clinical Practice Guideline provides key recommendations for managing cancer-related cachexia. • It covers screening, assessment and multimodal management of cancer cachexia. • All recommendations were compiled by a multidisciplinary group of experts. • Recommendations are based on available scientific data and the author's expert opinion.

Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines ☆

Abstract Gastric cancer (GC) ranks fifth in global cancer diagnosis and fourth in cancer-related death. Despite tremendous progress in diagnosis and therapeutic strategies and significant improvements in patient survival, the low malignancy stage is relatively asymptomatic and many GC cases are diagnosed at advanced stages, which leads to unsatisfactory prognosis and high recurrence rates. With the recent advances in genome analysis, biomarkers have been identified that have clinical importance for GC diagnosis, treatment, and prognosis. Modern molecular classifications have uncovered the vital roles that signaling pathways, including EGFR/HER2, p53, PI3K, immune checkpoint pathways, and cell adhesion signaling molecules, play in GC tumorigenesis, progression, metastasis, and therapeutic responsiveness. These biomarkers and molecular classifications open the way for more precise diagnoses and treatments for GC patients. Nevertheless, the relative significance, temporal activation, interaction with GC risk factors, and crosstalk between these signaling pathways in GC are not well understood. Here, we review the regulatory roles of signaling pathways in GC potential biomarkers, and therapeutic targets with an emphasis on recent discoveries. Current therapies, including signaling-based and immunotherapies exploited in the past decade, and the development of treatment for GC, particularly the challenges in developing precision medications, are discussed. These advances provide a direction for the integration of clinical, molecular, and genomic profiles to improve GC diagnosis and treatments. 

/pdf/signaling-pathways-and-therapeutic-interventions-in-gastric-1780pl43.pdf

Signaling pathways and therapeutic interventions in gastric cancer

The 2023 update of the Chinese Society of Clinical Oncology (CSCO) Clinical Guidelines for Gastric Cancer focuses on standardizing cancer diagnosis and treatment in China, reflecting the latest advancements in evidence‐based medicine, healthcare resource availability, and precision medicine. These updates address the differences in epidemiological characteristics, clinicopathological features, tumor biology, treatment patterns, and drug selections between Eastern and Western gastric cancer patients. Key revisions include a structured template for imaging diagnosis reports, updated standards for molecular marker testing in pathological diagnosis, and an elevated recommendation for neoadjuvant chemotherapy in stage III gastric cancer. For advanced metastatic gastric cancer, the guidelines introduce new recommendations for immunotherapy, anti‐angiogenic therapy and targeted drugs, along with updated management strategies for human epidermal growth factor receptor 2 (HER2)‐positive and deficient DNA mismatch repair (dMMR)/microsatellite instability‐high (MSI‐H) patients. Additionally, the guidelines offer detailed screening recommendations for hereditary gastric cancer and an appendix listing drug treatment regimens for various stages of gastric cancer. The 2023 CSCO Clinical Guidelines for Gastric Cancer updates are based on both Chinese and international clinical research and expert consensus to enhance their applicability and relevance in clinical practice, particularly in the heterogeneous healthcare landscape of China, while maintaining a commitment to scientific rigor, impartiality, and timely revisions.

The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2023

China, as the one of the largest developing countries in the world and with about one‐fifth of the global population, is bearing an increasing burden on health from cancer. In the area of esophageal cancer (EC), China accounts for more than 50% of the global cases, with this disease being a particularly worse for those in disadvantaged populations. Along with China's socioeconomic condition, the epidemiology, diagnosis, therapeutics and research of EC have developed throughout the 21st century. In the current review, existing control measures for EC in China are outlined, including the incidence, mortality, screening, clinical diagnosis, multidisciplinary treatment and research landscape. EC in China are very different from those in some other parts of the world, especially in Western countries. Core measures that could contribute to the prevention of EC and improve clinical outcomes in patients of less developed countries and beyond are recommended. International cooperation among academia, government and industry is especially warranted in global EC control.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ijc.34301

Esophageal cancer in China: Practice and research in the new era

PURPOSEEffective interventions to improve prognosis in metastatic esophagogastric cancer (EGC) are urgently needed. We assessed the effect of the early integration of interdisciplinary supportive c...

https://ascopubs.org/doi/pdfdirect/10.1200/JCO.20.01254

Early Interdisciplinary Supportive Care in Patients With Previously Untreated Metastatic Esophagogastric Cancer: A Phase III Randomized Controlled Trial

Objective To investigate the prevalence of nutritional risk and perioperative nutritional support status in the gastrointestinal cancer surgical patients.Methods Adult inpatients from the gastrointestinal cancer surgery department of our hospital were consecutively enrolled from May to September 2010.Nutritional Risk Screening 2002 ( NRS 2002) was performed at admission,and data of the nutritional support and complications during hospitalization were collected.The relationship between nutritional risk and postoperative complications was analyzed.Results A total of 195 patients were eligible.At admission,43.6％ (85/195) patients were "at risk" Of the patients "at risk",totally 11.7％ (10/85) patients received preoperative nutritional support,and 100％ (85/85) patients received postoperative nutritional support; of the patients "not at risk",no patients received preoperative nutritional support,and 84.5％ (93/110) patients received postoperative nutritional support.The overall rates of postoperative complications were 19.1％ ( 13/68 ) in the patients "at risk" while 7.1％ (9/127 )in the patients "not at risk" ( P =0.02).Conclusions Nutritional risk in gastrointestinal cancer surgical patients was high.The application of nutritional support was inappropriate in these patients.The nutritional risk is associated with higher postoperative complications.Dissemination of evidence-based guidelines should be enhanced.

Key words: 
Gastrointestinal carcinoma; Nutritional risk; Nutritional Risk Screening 2002; Nutritional support; Postoperative complications

Nutritional risk and nutritional support in gastrointestinal cancer surgical patients

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Early Interdisciplinary Supportive Care in Patients With Previously Untreated Metastatic Esophagogastric Cancer: A Phase III Randomized Controlled Trial

Nutritional risk and nutritional support in gastrointestinal cancer surgical patients