Пути повышения эффективности лечения местно-распространенных и метастатических форм злокачественных опухолей желудка на современном этапе
https://doi.org/10.18027/2224-5057-2025-15-3s1-38-46
Abstract
Тезисы: Диагностика ранних форм рака желудка (I–II стадии) остаётся на невысоком уровне. Большинство больных выявляются в запущенных (III–IV) стадиях. Лечение местнораспространенного и метастатического рака желудка неудовлетворительно и требует своего улучшения. Наряду с совершенствованием комбинированного хирургического лечения открытым лапаротомным доступом предпринимаются попытки лапароскопических вмешательств по поводу местнораспространенного рака желудка. В лечении также рассматривается обзор системной химиотерапии метастатического рака желудка, циторедуктивной хирургии, паллиативной внутрибрюшной химиотерапии, внутрибрюшной аэрозольной химиотерапии под давлением (PIPAC).
About the Authors
В. Сельчук
ФГБОУ ВО «Российский университет медицины» Минздрава России
Russian Federation
Competing Interests:
Russian Federation
Competing Interests:
Авторы заявляют об отсутствии возможных конфликтов интересов.
Т. Кочоян
ФГБОУ ВО «Российский университет медицины» Минздрава России
Russian Federation
Competing Interests:
Russian Federation
Competing Interests:
Авторы заявляют об отсутствии возможных конфликтов интересов.
О. Гребенникова
ФГБОУ ВО «Российский университет медицины» Минздрава России
Russian Federation
Competing Interests:
Russian Federation
Competing Interests:
Авторы заявляют об отсутствии возможных конфликтов интересов.
Г. Емельянова
ФГБОУ ВО «Российский университет медицины» Минздрава России
Russian Federation
Competing Interests:
Russian Federation
Competing Interests:
Авторы заявляют об отсутствии возможных конфликтов интересов.
С. Таджибов
ФГБОУ ВО «Российский университет медицины» Минздрава России
Russian Federation
Competing Interests:
Russian Federation
Competing Interests:
Авторы заявляют об отсутствии возможных конфликтов интересов.
Г. Титова
ФГБОУ ВО «Российский университет медицины» Минздрава России
Russian Federation
Competing Interests:
Russian Federation
Competing Interests:
Авторы заявляют об отсутствии возможных конфликтов интересов.
References
1. Каприн А.Д. и соавт. «Злокачественные новообразования в России в 2023 году (заболеваемость и смертность)» Москва 2025 г.
2. Бесова Н.С., Болотина Л.В., Гамаюнов С.В., и соавт. Практические рекомендации по лекарственному лечению рака желудка. Практические рекомендации RUSSCO, часть 1. Злокачественные опухоли, 2023 (том 13), #3s2, стр. 405–424. https://doi.org/10.18027/2224-5057-2023-13-3s2-1-405-424
3. Спартак А.А. Реконструктивный этап лапароскопических операций при осложненных формах местно-рас- пространенного рака дистального отдела желудка: Автореф. дисс. ... канд. мед. наук. М.; 2024
4. Хомяков В.М. Лечебная тактика у больных раком желудка с перитонеальным карциноматозом с применением сочетанной системной и внутрибрюшной химиотерапии и хирургической циторедукции: Автореф. дисс. ... докт. мед. наук. М.; 2025
5. Convie L., Thompson R.J., Kennedy R., et al. The current role of staging laparoscopy in oesophagogastric cancer. Ann R Coll Surg Engl 2015;97(2):146–50. https://doi.org/10.1308/003588414X14055925061270
6. Hu Y.F., Deng Z.-W., Liu H., et al. Staging laparoscopy improves treatment decision-making for advanced GC. World J Gastroenterol 2016;22(5):1859–68. https://doi.org/10.3748/wjg.v22.i5.1859
7. Montori G., Coccolini F., Ceresoli M., et al. The treatment of peritoneal carcinomatosis in advanced GC: state of the Art. Int J Surg Oncol 2014;2014:912418. https://doi.org/10.1155/2014/912418
8. Yang C., Yang Y., Huang X., et al. A nomogram based on clinicopathologic features and preoperative hematology para- metres to predict occult peritoneal metastasis of GC: a single-centre retrospective study. Dis Markers 2020;2020:1418978. https://doi.org/10.1155/2020/1418978
9. Koemans W., Lurvink R.J., Grootscholten C., et al. Synchronous peritoneal metastasis of gastric original: incidence, treatment and survival of nationwide Dutch cohort. Gastric Cancer 2021;24(4):800–809. https://doi.org/10.1007/s10120-021-01160-1
10. Munasinghe A., Kazi W., Taniere P., et al. The incremental benefit of two quadrant lavage for peritonedal cytology at staging laparoscopy for oesophagogastric adenocarcinoma. Surg Endoscop 2013;27(11):4049–53. https://doi.org/10.1007/s00464-013-3058-5
11. Seshadri R., Glehen O. Cytoreductive surgery and hyperthermic intraoperitoneal chemotherapy in gastric cancer. World J Gastroenerol 2016;22(3):1114–1130. https://doi.org/10.3748/wjg.22.i3.1114
12. Desiderio J., Chao J., Melstrom L., et al. The 30-year experience-A meta-analysis of randomized and high-quality non randomized studies of hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer. Eur J Cancer 2017;79:1–14. https://doi.org/10.1016/j.ejca.2017.03.030
13. Maehara Y., Hasuda S., Koga T., et al. Postoperative outcome and sites of recurrence in patients following curative resection of gastric cancer. Br J Surg 2000;87(3):353–57. https://doi.org/10.1046/j.1365-2168.2000.01358.x
14. D’Angelica M., Gonen M., Brennan M.F., et al. Patterns of initial recurrence in completely resected gastric adenocar- cinoma. Ann Surg 2004;240(5):808–16. https://doi.org/10.1097/01.sla.0000143245.28656.15
15. Lee J., Son S.-Y., Lee C.M., et al. Factors predicting peritoneal recurrence in advanced GC: implication for adjuvant intraperitoneal chemotherapy. Gastric Cancer 2014;17(3):529–36. https://doi.org/10.1007/s10120-013-0306-2
16. Kaya D., Nogueras-González G.M., Harada K., et al. Risk of peritoneal metastasis in patient who had negative peri- toneal staging and received therapy for localized gastric adenocarcinoma. J Surg Oncol 2018;117(4):678–84. https://doi.org/10.1002/jso.24912
17. Seyfried F., von Rahden B.H., Miras A.D., et al. Incidence, time course and independent risk factors for metachronous ptritoneal carcinomatosis of gastric origin – a longitudinal experience from a prospectively collected database of 1108 patients. BMS Cancer 2015;15:73. https://doi.org/10.1186/s12885-015-1081-8
18. Henson D., Dittus C., Younes M., et al. Differential trends in the intestinal and diffuse types of gastric carcinoma in the United States, 1973–2000: increase in the signet ring cell type. Arch Pathol Lab Med 2004;128(7):765–70. https://doi.org/10.5858/2004-128-765-DTITIA
19. Lee J., Chang K.K., Yoon C., et al. Lauren histologic type is the most important factor associated with pattern of recurrence fol- lowing resection of gastric adenocarcinoma. Ann Surg 2018;267(1):105–113. https://doi.org/10.1097/SLA.0000000000002040
20. Luo Y., Gao P., Song Y., et al. Clinicopathologic characteristics and prognosis of Borrmann type IV gastric cancer: a meta-analysis. World J Surg Oncol 2016;14(1):49. https://doi.org/10.1186/s12957-016-0805-9
21. Tan I., Ivanova T., Lim K.H., et al. Intrinsic subtypes of gastric cancer, based on gene expression pattern, predict survival and respond differently to chemotherapy. Gastroenterology 2011;141(2):476–85. https://doi.org/10.1053/j.gastro.2011.04.042
22. Lei Z., Tan I.B., Das K., et al. Identification of molecular subtypes of GC with different responses to P13-kinase in- hibitors and 5-fluorouracil. Gastroenterology 2013;145(3):554–56. https://doi.org/10.1053/j.gastro.2013.05.010
23. Kotelnikova E., Pyatnitskiy M., Paleeva A. Practical aspects of NGS-based pathways analysis for personalized cancer science and medicine. Oncotarget 2016;7(32):52493–52516. https://doi.org/10.18632/oncotarget.9370
24. Moreno-Cabrera J., Del Valle J., Castellanos E., et al. Evaluation of detection tools for NGS panel data in genetic diagnostics. Eur J Hum Genet 2020;28(12):1645–1655. https://doi.org/10.1038/s41431-020-0675-z
25. Cancer Genome Atlas Research Network. Comprehensive molecular characterization of gastric adenocarcinoma. Nature 2014;513(7517):202–9. https://doi.org/10.1038/nature13480
26. Cristescu R., Lee J., Nebozhyn M., et.al. Molecular Analysis of gastric Cancer indentifies subtypes associated with distinct clinical outcomes. Nat Med 2015;21:449–56. https://doi.org/10.1038/nm.3850
27. Хэнянь С. Клиническое значение микросателлитной нестабильности в лечении больных раком желудка: Авто- реф. дисс. ... канд. мед. наук. М.; 2025
28. Pietrantonio F. Multicenter, Single-Arm, Multi-Cohort, Phase II INFINITY Trial: Tremelimumab & Durvalumab as Neoadjuvant Treatment of Patients With MSI-H Resectable GC/GEJC. Available at: https://www.vumedi.com/channel/asco-gi-2023-conference-coverage/
29. Smyth E.C., Wotherspoon A., Peckitt C., et al. Mismatch Repair Deficiency, Microsatellite Instability, and Survival: an Exploratory Analysis of the Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) Trial. JAMA 2017;3(9):1197–1203. https://doi.org/10.1001/jamaoncol.2016.6762
30. Sunakawa Y., Lenz H.-J. Molecular classification of gastric adenocarcinoma: translating new insights from the cancer genome atlas research network. Curr Treat Options Oncol 2015;16(4):17. https://doi.org/10.1007/s11864-015-0331-y
31. Zouridis H., Deng N., Ivanova T., et al. Methylation subtypes and large-scale epigenetic alterations in gastric cancer. Sci Transl Med 2012;4(156):156ra140. https://doi.org/10.1126/scitranslmed.3004504
32. Guan W., He Y., Xu R.-H., et al. Gastric cancer treatment: recent progress and future perspectives. J Hematol Oncol 2023;16(1):57. https://doi.org/10.1186/s13045-023-01451-3
33. Li J.J., Rogers J.E., Yamashita K., et al. Therapeutic advances in the treatment of gastroeosophgeal cancers. Biomole- cules 2023;13(5):796. https://doi.org/10.3390/biom13050796
34. Nevo Y., Ferri L. Current management of gastric carcinoma: a narrative review. J Gastrointest Oncol 2023;14(4):1933–48. https://doi.org/10.21037/jgo-22-818
35. Rogers J.E., Jaffer A.A. Recent advances in the management of gastric adenocarcinoma patients. Fac Rev 2023:12:2. https://doi.org/10.12703/r/12-2
36. Sato Y., Okamoto K., Kida Y., et al. Overview of chemotherapy for gastric cancer. J Clin Med 2023;12(4):1336. https://doi.org/10.3390/jcm12041336
37. Cann C., Ciombor K.K. Systemic therapy for gastric cancer: Perioperative strategies and beyond. J Surg Oncol 2022;125(7):1151–1160. https://doi.org/10.1002/jso.26834
38. Bang Y.J., Van Cutsem E., Feyereislova A., et al. Trastuzumab in combination with chemotherapy versus chemother- apy alone for treatment of HER-2-positive advanced gastric or gastro-eosophageal junction cancer (ToGA):a phase 3, open-label, randomized controlled trial. Lancet 2010;376(9742):687–97. https://doi.org/10.1016/S0140-6736(10)61121-X
39. Janjigian Y.Y., Kawazoe A., Yañez P., et al. The KEYNOTE-811 trial of dual PD-1 and HER2 blockade in HER2-pos- itive gastric cancer. Nature 2021;600(7890):727–30. https://doi.org/10.1038/s41586-021-04161-3
40. Sun J.-M., Shen L., Shah M.A., et al. Pembrolizumab plus chemotherapy versus chemotherapy alone for first line treatment of advanced oesophageal cancer (KEYNOTE-590): a randomized, placebo-controlled, phase 3 study. Lancet 2021;398(10302):759–71. https://doi.org/10.1016/S0140-6736(21)01234-4
41. Yoon J., Kim T.-Y., Oh D.-Y., et al. Recent progress in immunotherapy for gastric cancer. J Gastric Cancer 2023;23(1):207– 223. https://doi.org/10.5230/jgc.2023.23.e10
42. Fuca G., Cohen R., Lonardi S., et al. Ascites abd resistance to immune checkpoint inhibition in dMMR/MSI-H meta- static colorectal and gastric cancers. J Immunother Cancer 2022;10(2):e004001. https://doi.org/10.1136/jitc-2021-004001
43. Randon G., Aoki Y., Cohen R., et al. Outcomes and a prognostic classifier in patients with microsatellite instability-high meta- static gastric cancer receiving PD-1 blockade. J Immunother Cancer 2023;11(6):e007104. https://doi.org/10.1136/jitc-2023-007104
44. Wilke H., Muro K., Van Cutsem E., et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomized phase 3 trial. Lancet Oncol 2014;15(11):1224–35. https://doi.org/10.1016/S1470-2045(14)70420-6
45. Lorenzen S., Thuss-Patience P., Pauligk C., et al. FOLFIRI plus ramucirumab versus paclitaxel plus ramicirumab as second-line therapy for patients with advanced or metastatic gastroesophageal adenocarcinoma with or without prior docetaxel – results from the phase II RAMIRIS Study of the German Gastric Cancer Study Group at AIO. Eur J Cancer 2022;165:48–57. https://doi.org/10.1016/j.ejca.2022.01.015
46. Shitara K., Bang Y.-J., Iwasa S., et al. Trastuzumab deruxtecan in previously treated HER2-positive gastric cancer. N Engl J Med 2025;382(25):2419–2430. https://doi.org/10.1056/NEJMoa2004413
47. Sahin U., Türeci Ö., Manikhas G., et al. FAST: a randomized phase II study of zolbetuximab (IMAB362) plus EOX versus FOX alone for first-line treatment of advanced CLDN18.2-positive gastric and gastro-oesophageal adenocar- cinoma. Ann Oncol 2021;32(5):609–619. https://doi.org/10.1016/j.annonc.2021.02.005
48. Sun B.J., Lee B. Review of Regional Therapies for Gastric Cancer with Peritoneal Metastases. Cancers (Basel) 2022;14(3):570. https://doi.org/10.3390/cancers14030570
49. Lordic F., Al-Batran S.-E., Arnold D., et al. German, Austrian and Swiss guideline lines for systemic treatment of gastric cancer. Gastric Cancer 2024;27(1):6–18. https://doi.org/10.1007/s10120-023-01424-y
50. Fuigitani K., Yang H.-K., Mizusawa J., et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3 randomised controlled trial. Lancet Oncol 2016;17(3):309–18. https://doi.org/10.1016/S1470-2045(15)00553-7
51. Al-Batran S.-E., Homann N., Pauligk C., et al. Effect of neoadjuvant chemotherapy followed by surgical resection on survival in patients with limited metastatic gastric or gastroesophageal junction cancer: the AIO-FLOT3 Trial. JAMA Oncol 2017;3(9):1237–1244. https://doi.org/10.1001/jamaoncol.2017.0515
52. Fujimoto S., Shrestha R.D., Kokubun M., et al. Intraperitoneal hyperthermic perfusion combined with surgery effective for gastric cancer patients with peritoneal seeding. Ann Surg 1988;208(1):36–41. https://doi.org/10.1097/00000658-198807000-00005
53. Prabhu A., Mishra D., Brandl A., Yonemura Y., et al. Gastric cancer with peritoneal metastasis – a comprehensive reviw of current intraperitoneal treatment modalities. Front Oncol 2022;12:864647. https://doi.org/10.3389/fonc.2022.864647
54. Ukegjini K., Guidi M., Lehmann K., et al. Current research and development in Hyperthermic Intraperitoneal Chemo- therapy (HIPEC)- a cross-sectional analysis of clinical trials registered on ClinicalTrials.gov. Cancer 2023;15(7):1926. https://doi.org/10.3390/cancers15071926
55. Glehen O., Gilly F.N., Arvieux C., et al. Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol 2010;17(9):2370–2377. https://doi.org/10.1245/s10434-010-1039-7
56. Yang X.-J., Huang C.-Q., Suo T., et al. Cytoreductive surgery and hypertermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol 2011;18(6):1575–81. https://doi.org/10.1245/s10434-011-1631-5
57. Bonnot P.-E., Piessen G., Kepenekian V., et al. Cytoreductive surgery with or without hypertermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastases (CYTO-CHIP study): a propensity score analysis. J Clin Oncol 2019;37(23):2028–2040. https://doi.org/10.1200/JCO.18.01688
58. Yoshida K., Yamaguchi K., Okumura N., et al. The role of surgical oncologists in the new era: minimally invasive surgery for the early GC and adjuvant surgery for metastatic gastric cancer. Pathobiology 2011;78(6):343–352. https://doi.org/10.1159/000328197
59. Yonemura Y., Bandou E., Sawa T., et al. Neoadjuvant treatment of gastric cancer with peritoneal dissemination. Eur J Surg Oncol 2006;32(6):661–665. https://doi.org/10.1016/j.ejso.2006.03.007
60. Yonemura Y., Elnemr A., Endou Y., et al. Effects of neoadjuvant intraperitoneal/systemic chemotherapy (bidirec- tional chemotherapy) for the treatment of patients with peritoneal metastasis from gastric cancer. Int J Surg Oncol 2012;2012:148420. https://doi.org/10.1155/2012/148420
61. Ishigami,H.,Yamaguchi,H.,Yamashita,H.,etal.Surgeryafterintraperitonealandsystemicchemotherapyforgastriccancer- withperitonealmetastasisorpositiveperitonealcytologyfindings.GastricCancer20(Suppl1),128-134(2017).https://doi.org/10.1007/s10120-016-0684-3.
Review
For citations:
, , , , , . Malignant tumours. 2025;15(3s1):38-46. (In Russ.) https://doi.org/10.18027/2224-5057-2025-15-3s1-38-46
Views:
255
JATS XML
Email this article 