《肿瘤瞭望》：您能和我们介绍一下针对进展期胃癌的标准化治疗有哪些吗？

　　Oncology Frontier: Can you introduce the standard treatment for advanced gastric cancer?

　　Dr. Noh：当前对于进展期胃癌的标准化治疗方案是以根治性胃切除联合D2淋巴结清扫为主的综合治疗。在21世纪以前，胃癌被认为对化疗不敏感，所以手术被认为是针对胃癌的唯一的标准化治疗方案。但是现在发现手术联合化疗无疑可以带来生存获益。在没办法进行根治性胃切除术后，增加放疗治疗同样也能获益。总言之，当前针对进展期胃癌的标准治疗应该是综合治疗。

　　Dr. Noh: The current standard treatment for advanced gastric cancer is multidisciplinary treatment centered around radical gastrectomy with D2 lymph node dissection. Before 21st century， it was considered that gastric cancer is refractory to chemotherapy， so the surgery is the only standard treatment for gastric cancer. Now， however， there is no doubt that adding chemotherapy to surgery provides survival benefit， and radiation therapy would be benefit after gastrectomy with limited lymph node dissection. In summary， current standard treatment for advanced gastric cancer is multidisciplinary treatment.

　　《肿瘤瞭望》：针对进展期胃癌，手术治疗的意义还重不重要，您是如何看待这个问题的？手术治疗能够提高总生存时间吗？

　　Oncology Frontier: What do you think of the significance of surgery for advanced gastric cancer patients? Can surgical treatment improve their overall survival?

　　Dr. Noh：对于进展期胃癌，手术质量是非常重要的。经过几十年的争论，对于进展期胃癌的手术根治程度最终被定为D2根治。当与胃癌D0或者D1根治切除的患者预后想比较，D2根治切除的患者的预后明显较好。因此，我不禁要强调手术治疗对进展期胃癌的重要性。但是，我们也知道如果由那些D2根治术不是很熟练的外科医生实施胃切除术，术后的并发症和死亡率会很高。所以，加强标准D2根治术的教育是攻克胃癌的一个重要措施。高质量的手术是治疗进展期胃癌的一个最基本的先决条件。

　　Dr. Noh: The quality of surgery for advanced gastric cancer is very important. After decades of debate， the extent of surgery for advanced gastric cancer is decided into D2 level. When comparing the outcomes of gastrectomy with limited lymph node dissection (D0 or D1 surgery) to those of radical D2 surgery， the prognosis after radical D2 surgery is much better， consequently， I cannot help but emphasize the importance of surgery for advanced gastric cancer. However， it is known that performing D2 surgery by inexperienced-hands sometimes cause high morbidity and even mortality. Thus， education for propagating standard radical D2 surgery is one of the important goals to conquer gastric cancer. Qualified surgery is basic prerequisite to treat advanced gastric cancer.

　　《肿瘤瞭望》：针对晚期胃癌患者，精确医疗有没有适用性，您是怎样看待这个问题的？

　　Oncology Frontier: Do you think precision medicine applies to advanced gastric cancer patients? Why or why not?

　　Dr. Noh：精准医疗是医学发展的一个必然趋势，特别是在肿瘤的研究和实践中。尽管化疗的获益是被证明了，但是只有大约10-15%的进展期胃癌患者能够从化疗中获益。而大于50%的进展期胃癌患者通过单纯的D2根治性手术就能获益。这些结果表明一些进展期胃癌患者可以通过单纯的手术就能治愈。所以如果我们能够预判哪些人对化疗敏感，哪些人对化疗不敏感，从而可以让哪些没办法从化疗中获益的患者避免化疗。对于乳腺癌患者，像Oncotype DX这种可以预测预后和判断化疗敏感性的基因测序技术已经运用到临床实践中了。在肿瘤生物和生物技术方面的最新进展都在进一步提升我们对胃癌特征的理解。所以我们应该通过生物标志物去对胃癌进行分类，然后通过这些生物标志物进行靶向治疗。对于胃癌的精准医学已经在我们的考虑当中，在不久的将来这必将成为征服进展期胃癌的治疗方法。

　　Dr. Noh: Precision medicine is a general trend in medicine and， especially in cancer research and practice. Despite the benefits of chemotherapy is proved， only 10~15% of patients with advanced gastric cancer get benefits from it. And over 50% of patients are survived from advanced gastric cancer after treating by radical D2 surgery alone. These results imply that some of the advanced gastric cancer can be cured by only surgery， so if we can predict who will and will not respond to chemotherapy， some of the patients can be spared from unnecessary chemotherapy. In case of breast cancer， a prognostic and predictive to chemo-responsiveness markers such as Oncotype DX， has been applied in clinical practice. Recent advancements in cancer biology and biotechnology have improved the understanding of characteristics of gastric cancer， and we have to go to the biomarker-based classification of gastric cancer and applying targeted treatment. Precision medicine for gastric cancer is at our hands， it would be the way for conquering advanced gastric cancer.