• 1.中國(guó)醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院（北京 100730）;;
  • 2.北京協(xié)和醫(yī)院核醫(yī)學(xué)科PET中心（北京 100730）;;
  • 3.北京協(xié)和醫(yī)院基本外科（北京 100730）;

目的  研究胃癌新輔助化療療效臨床評(píng)價(jià)方法及進(jìn)展。
方法  對(duì)有關(guān)胃癌新輔助化療療效臨床評(píng)價(jià)方法的文獻(xiàn)進(jìn)行綜述分析，比較CT、EUS、MRI及PET的評(píng)價(jià)結(jié)果與術(shù)后病理、預(yù)后結(jié)果的符合度。
結(jié)果  CT、EUS是目前臨床中常用的療效評(píng)價(jià)方法，但是其評(píng)價(jià)指標(biāo)和標(biāo)準(zhǔn)不統(tǒng)一, 胃癌套用現(xiàn)有的實(shí)體瘤療效評(píng)價(jià)標(biāo)準(zhǔn)似乎并不適用; 采用磁共振擴(kuò)散加權(quán)成像（DWI）評(píng)價(jià)胃癌新輔助化療療效還有待進(jìn)一步研究; PET在早期準(zhǔn)確篩選出化療無(wú)效病例方面具有優(yōu)勢(shì)。
結(jié)論  胃癌新輔助化療療效臨床評(píng)價(jià)尚缺乏統(tǒng)一標(biāo)準(zhǔn)，各種影像學(xué)方法的綜合應(yīng)用可能有利于提高評(píng)價(jià)的準(zhǔn)確性。

引用本文： 汪劭婷,朱朝暉,李小毅. 胃癌新輔助化療療效臨床評(píng)價(jià)方法及進(jìn)展. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(2): 200-204. doi: 復(fù)制

1. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer [J]. N Engl J Med, 2006; 355(1): 1120.
2. Boige V, Pignon J, SaintAubert B, et al. Final results of a randomized trial comparing preoperative 5fluorouracil (F)/cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07FFCD 9703 trial [J]. J Clin Oncol (Meeting Abstracts), 2007; 25(18S): 4510.
3. 方育, 王亞軍, 李非, 等. 奧沙利鉑聯(lián)合甲酰四氫葉酸鈣和氟尿嘧啶新輔助化療方案治療進(jìn)展期胃癌的研究 [J]. 中華胃腸外科雜志, 2006; 9(6): 510512.
4. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Gastric cancer (NCCN).v.2. 2009. http://www.nccn.org/professionals/physician_gls/PDF/gastric.pdf.
5. Ninomiya Y, Yanagisawa A, Kato Y, et al. Histological indications of a favorable prognosis with faradvanced gastric carcinomas after preoperative chemotherapy [J]. J Cancer Res Clin Oncol, 1999; 125(12): 699706.
6. Becker K, Mueller JD, Schulmacher C, et al. Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy [J]. Cancer, 2003; 98(7): 15211530.
7. Weber WA, Ott K, Becker K, et al. Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging [J]. J Clin Oncol, 2001; 19(12): 30583065.
8. Ott K, Fink U, Becker K, et al. Prediction of response to preoperative chemotherapy in gastric carcinoma by metabolic imaging: results of a prospective trial [J]. J Clin Oncol, 2003; 21(24): 46044610.
9. Ott K, Weber WA, Lordick F, et al. Metabolic imaging predicts response, survival, and recurrence in adenocarcinomas of the esophagogastric junction [J]. J Clin Oncol, 2006; 24(29): 46924698.
10. Lordick F, Ott K, Krause BJ, et al. PET to assess early metabolic response and to guide treatment of adenocarcinoma of the oesophagogastric junction: the MUNICON phase Ⅱ trial [J]. Lancet Oncol, 2007; 8(9): 754755.
11. Miller AB, Hoogstraten B, Staquet M, et al. Reporting results of cancer treatment [J]. Cancer, 1981; 47(1): 207214.
12. Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors [J]. J Natl Cancer Inst, 2000; 92(3): 205216.
13. Young H, Baum R, Cremerius U, et al. Measurement of clinical and subclinical tumour response using [18F]fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group [J]. Eur J Cancer, 1999; 35(13): 17731782.
14. Choi H, Charnsangavej C, Faria SC, et al. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria [J]. J Clin Oncol, 2007; 25(13): 17531759.
15. 嚴(yán)超, 朱正綱, 燕敏, 等. 內(nèi)鏡超聲檢查和多層螺旋CT對(duì)胃癌淋巴結(jié)轉(zhuǎn)移狀況的評(píng)估價(jià)值 [J]. 中華外科雜志, 2005; 43(3): 174176.
16. 嚴(yán)超, 朱正綱, 燕敏, 等. 多排CT 對(duì)早期胃癌術(shù)前評(píng)估的價(jià)值 [J]. 外科理論與實(shí)踐, 2008; 13(1): 3439.
17. Allum WH, Griffin SM, Watson A, et al. Guidelines for the management of oesophageal and gastric cancer [J]. Gut, 2002; 50(Suppl 5): 123.
18. Shimizu1 K, Ito K, Matsunaga N, et al. Diagnosis of gastric cancer with MDCT using the waterfilling method and multiplanar reconstruction: CThistologic correlation [J]. AJR Am J Roentgenol, 2005; 185(5): 11521158.
19. Park SR, Lee JS, Kim CG, et al. Endoscopic ultrasound and computed tomography in restaging and predicting prognosis after neoadjuvant chemotherapy in patients with locally advanced gastric cancer [J]. Cancer, 2008; 112(11): 23682376.
20. Di Fabio F, Pinto C, Rojas Llimpe FL, et al. The predictive value of 18FFDGPET early evaluation in patients with metastatic gastric adenocarcinoma treated with chemotherapy plus cetuximab [J]. Gastric Cancer, 2007; 10(4): 221227.
21. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma－2nd English edition: response assessment of chemotherapy and radiotherapy for gastric carcinoma: clinical criteria [J]. Gastric Cancer, 2001; 4(1): 18.
22. Kurihara M, Aiko T. The new Japanese classification of gastric carcinoma: revised explanation of “response assessment of chemotherapy and radiotherapy for gastric carcinoma” [J]. Gastric Cancer, 2001; 4(1): 913.
23. Benjamin RS, Choi H, Macapinlac HA, et al. We should desist using RECIST, at least in GIST [J]. J Clin Oncol, 2007; 25 (13): 17601764.
24. Lee SM, Kim SH, Lee JM, et al. Usefulness of CT volumetry for primary gastric lesions in predicting pathologic response to neoadjuvant chemotherapy in advanced gastric cancer [J]. Abdom Imaging, 2009; 34(4): 430440.
25. 嚴(yán)超, 朱正綱, 燕敏， 等. 內(nèi)鏡超聲檢查對(duì)胃癌術(shù)前分期的價(jià)值 [J]. 中國(guó)內(nèi)鏡雜志, 2003; 9(5): 3236.
26. Mesenas S, Vu C, McStay M, et al. A large series, resection controlled study to assess the value of radial EUS in restaging gastroesophageal cancer following neoadjuvant chemotherapy [J]. Dis Esophagus, 2008; 21(1): 3742.
27. Blackshaw G, Lewis WG, Hopper AN, et al. Prospective comparison of endosonography, computed tomography, and histopathological stage of junctional oesophagogastric cancer [J]. Clin Radiol, 2008; 63(10): 10921098.
28. Motohara T, Semelka RC. MRI in staging of gastric cancer [J]. Abdom Imaging, 2002; 27(4): 376383.
29. Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review [J]. J Clin Oncol, 2007; 25(15): 21072116.
30. Arocena MG, Barturen A, Bujanda L, et al. MRI and endoscopic ultrasonography in the staging of gastric cancer [J]. Rev Esp Enferm Dig, 2006; 98(8): 582590.
31. Roth Y, Tichler T, Kostenich G, et al. Highbvalue diffusionweighted MR imaging for pretreatment prediction and early monitoring of tumor response to therapy in mice [J]. Radiology, 2004; 232(3): 685692.
32. Thoeny HC, De Keyzer F, Chen F, et al. Diffusionweighted MR imaging in monitoring the effect of a vascular targeting agent on rhabdomyosarcoma in rats [J]. Radiology, 2005; 234(3): 756764.
33. Naganawa S, Sato C, Kumada H, et al. Apparent diffusion coefficient in cervical cancer of the uterus: comparison with the normal uterine cervix [J]. Eur Radiol, 2005; 15(1): 7178.
34. Batchelor TT, Sorensen AG, di Tomaso E, et al. AZD2171, a panVEGF receptor tyrosine kinase inhibitor, normalizes tumor vasculature and alleviates edema in glioblastoma patients [J]. Cancer Cell, 2007; 11(1): 8395.
35. Esteves FP, Schuster DM, Halkar RK. Gastrointestinal tract malignancies and positron emission tomography: an overview [J]. Semin Nucl Med, 2006; 36(2):169181.
36. Dehdashti F, Siegel BA. Neoplasms of the esophagus and stomach [J]. Semin Nucl Med, 2004; 34(3): 198208.
37. Yun M, Lim JS, Noh SH, et al. Lymph node staging of gastric cancer using 18FFDG PET: a comparison study with CT [J]. J Nucl Med, 2005; 46(10): 15821588.
38. Kim SK, Kang KW, Lee JS, et al. Assessment of lymph node metastases using 18FFDG PET in patients with advanced gastric cancer [J]. Eur J Nucl Med Mol Imaging, 2006; 33(2): 148155.
39. Chen J, Cheong JH, Yun MJ, et al. Improvement in preoperative staging of gastric adenocarcinoma with positron emission tomography [J].Cancer, 2005; 103(11): 23832390.
40. Suttie SA, Welch AE, Park KG. Positron emission tomography for monitoring response to neoadjuvant therapy in patients with oesophageal and gastrooesophageal junction carcinoma [J]. Eur J Surg Oncol, 2009; 35(10): 10191029.
41. Yun M, Choi HS, Yoo E, et al. The role of gastric distention in differentiating recurrent tumor from physiologic uptake in the remnant stomach on 18FFDG PET [J]. J Nucl Med, 2005; 46(6): 953957.
42. Tian J, Chen L, Wei B, et al. The value of vesicant 18Ffluorodeoxyglucose positron emission tomography (18FFDG PET) in gastric malignancies [J]. Nucl Med Commun, 2004; 25(8): 825831.
43. Imperiale A, Cimarelli S, Sellem DB, et al. Focal F18 FDG uptake mimicking malignant gastric localizations disappearing after water ingestion on PET/CT images [J]. Clin Nucl Med, 2006; 31(12): 835837.
44. Zhu Z, Li F, Mao Y, et al. Improving evaluation of primary gastric malignancies by distending the stomach with milk immediately before 18FFDG PET scanning [J]. J Nucl Med Technol, 2008; 36(1): 2529.
45. Zhu Z, Li F, Zhuang H. Gastric distension by ingesting food is useful in the evaluation of primary gastric cancer by FDG PET [J]. Clin Nucl Med, 2007; 32(2): 106109.
46. Ott K, Lordick F, Herrmann K, et al. The new credo: induction chemotherapy in locally advanced gastric cancer: consequences for surgical strategies [J]. Gastric Cancer, 2008; 11(1): 19.
47. 季加孚. 胃癌外科的現(xiàn)狀與發(fā)展趨勢(shì) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(1): 13.
  1. 1. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer [J]. N Engl J Med, 2006; 355(1): 1120.
  2. 2. Boige V, Pignon J, SaintAubert B, et al. Final results of a randomized trial comparing preoperative 5fluorouracil (F)/cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07FFCD 9703 trial [J]. J Clin Oncol (Meeting Abstracts), 2007; 25(18S): 4510.
  3. 3. 方育, 王亞軍, 李非, 等. 奧沙利鉑聯(lián)合甲酰四氫葉酸鈣和氟尿嘧啶新輔助化療方案治療進(jìn)展期胃癌的研究 [J]. 中華胃腸外科雜志, 2006; 9(6): 510512.
  4. 4. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Gastric cancer (NCCN).v.2. 2009. http://www.nccn.org/professionals/physician_gls/PDF/gastric.pdf.
  5. 5. Ninomiya Y, Yanagisawa A, Kato Y, et al. Histological indications of a favorable prognosis with faradvanced gastric carcinomas after preoperative chemotherapy [J]. J Cancer Res Clin Oncol, 1999; 125(12): 699706.
  6. 6. Becker K, Mueller JD, Schulmacher C, et al. Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy [J]. Cancer, 2003; 98(7): 15211530.
  7. 7. Weber WA, Ott K, Becker K, et al. Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging [J]. J Clin Oncol, 2001; 19(12): 30583065.
  8. 8. Ott K, Fink U, Becker K, et al. Prediction of response to preoperative chemotherapy in gastric carcinoma by metabolic imaging: results of a prospective trial [J]. J Clin Oncol, 2003; 21(24): 46044610.
  9. 9. Ott K, Weber WA, Lordick F, et al. Metabolic imaging predicts response, survival, and recurrence in adenocarcinomas of the esophagogastric junction [J]. J Clin Oncol, 2006; 24(29): 46924698.
  10. 10. Lordick F, Ott K, Krause BJ, et al. PET to assess early metabolic response and to guide treatment of adenocarcinoma of the oesophagogastric junction: the MUNICON phase Ⅱ trial [J]. Lancet Oncol, 2007; 8(9): 754755.
  11. 11. Miller AB, Hoogstraten B, Staquet M, et al. Reporting results of cancer treatment [J]. Cancer, 1981; 47(1): 207214.
  12. 12. Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors [J]. J Natl Cancer Inst, 2000; 92(3): 205216.
  13. 13. Young H, Baum R, Cremerius U, et al. Measurement of clinical and subclinical tumour response using [18F]fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group [J]. Eur J Cancer, 1999; 35(13): 17731782.
  14. 14. Choi H, Charnsangavej C, Faria SC, et al. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria [J]. J Clin Oncol, 2007; 25(13): 17531759.
  15. 15. 嚴(yán)超, 朱正綱, 燕敏, 等. 內(nèi)鏡超聲檢查和多層螺旋CT對(duì)胃癌淋巴結(jié)轉(zhuǎn)移狀況的評(píng)估價(jià)值 [J]. 中華外科雜志, 2005; 43(3): 174176.
  16. 16. 嚴(yán)超, 朱正綱, 燕敏, 等. 多排CT 對(duì)早期胃癌術(shù)前評(píng)估的價(jià)值 [J]. 外科理論與實(shí)踐, 2008; 13(1): 3439.
  17. 17. Allum WH, Griffin SM, Watson A, et al. Guidelines for the management of oesophageal and gastric cancer [J]. Gut, 2002; 50(Suppl 5): 123.
  18. 18. Shimizu1 K, Ito K, Matsunaga N, et al. Diagnosis of gastric cancer with MDCT using the waterfilling method and multiplanar reconstruction: CThistologic correlation [J]. AJR Am J Roentgenol, 2005; 185(5): 11521158.
  19. 19. Park SR, Lee JS, Kim CG, et al. Endoscopic ultrasound and computed tomography in restaging and predicting prognosis after neoadjuvant chemotherapy in patients with locally advanced gastric cancer [J]. Cancer, 2008; 112(11): 23682376.
  20. 20. Di Fabio F, Pinto C, Rojas Llimpe FL, et al. The predictive value of 18FFDGPET early evaluation in patients with metastatic gastric adenocarcinoma treated with chemotherapy plus cetuximab [J]. Gastric Cancer, 2007; 10(4): 221227.
  21. 21. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma－2nd English edition: response assessment of chemotherapy and radiotherapy for gastric carcinoma: clinical criteria [J]. Gastric Cancer, 2001; 4(1): 18.
  22. 22. Kurihara M, Aiko T. The new Japanese classification of gastric carcinoma: revised explanation of “response assessment of chemotherapy and radiotherapy for gastric carcinoma” [J]. Gastric Cancer, 2001; 4(1): 913.
  23. 23. Benjamin RS, Choi H, Macapinlac HA, et al. We should desist using RECIST, at least in GIST [J]. J Clin Oncol, 2007; 25 (13): 17601764.
  24. 24. Lee SM, Kim SH, Lee JM, et al. Usefulness of CT volumetry for primary gastric lesions in predicting pathologic response to neoadjuvant chemotherapy in advanced gastric cancer [J]. Abdom Imaging, 2009; 34(4): 430440.
  25. 25. 嚴(yán)超, 朱正綱, 燕敏， 等. 內(nèi)鏡超聲檢查對(duì)胃癌術(shù)前分期的價(jià)值 [J]. 中國(guó)內(nèi)鏡雜志, 2003; 9(5): 3236.
  26. 26. Mesenas S, Vu C, McStay M, et al. A large series, resection controlled study to assess the value of radial EUS in restaging gastroesophageal cancer following neoadjuvant chemotherapy [J]. Dis Esophagus, 2008; 21(1): 3742.
  27. 27. Blackshaw G, Lewis WG, Hopper AN, et al. Prospective comparison of endosonography, computed tomography, and histopathological stage of junctional oesophagogastric cancer [J]. Clin Radiol, 2008; 63(10): 10921098.
  28. 28. Motohara T, Semelka RC. MRI in staging of gastric cancer [J]. Abdom Imaging, 2002; 27(4): 376383.
  29. 29. Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review [J]. J Clin Oncol, 2007; 25(15): 21072116.
  30. 30. Arocena MG, Barturen A, Bujanda L, et al. MRI and endoscopic ultrasonography in the staging of gastric cancer [J]. Rev Esp Enferm Dig, 2006; 98(8): 582590.
  31. 31. Roth Y, Tichler T, Kostenich G, et al. Highbvalue diffusionweighted MR imaging for pretreatment prediction and early monitoring of tumor response to therapy in mice [J]. Radiology, 2004; 232(3): 685692.
  32. 32. Thoeny HC, De Keyzer F, Chen F, et al. Diffusionweighted MR imaging in monitoring the effect of a vascular targeting agent on rhabdomyosarcoma in rats [J]. Radiology, 2005; 234(3): 756764.
  33. 33. Naganawa S, Sato C, Kumada H, et al. Apparent diffusion coefficient in cervical cancer of the uterus: comparison with the normal uterine cervix [J]. Eur Radiol, 2005; 15(1): 7178.
  34. 34. Batchelor TT, Sorensen AG, di Tomaso E, et al. AZD2171, a panVEGF receptor tyrosine kinase inhibitor, normalizes tumor vasculature and alleviates edema in glioblastoma patients [J]. Cancer Cell, 2007; 11(1): 8395.
  35. 35. Esteves FP, Schuster DM, Halkar RK. Gastrointestinal tract malignancies and positron emission tomography: an overview [J]. Semin Nucl Med, 2006; 36(2):169181.
  36. 36. Dehdashti F, Siegel BA. Neoplasms of the esophagus and stomach [J]. Semin Nucl Med, 2004; 34(3): 198208.
  37. 37. Yun M, Lim JS, Noh SH, et al. Lymph node staging of gastric cancer using 18FFDG PET: a comparison study with CT [J]. J Nucl Med, 2005; 46(10): 15821588.
  38. 38. Kim SK, Kang KW, Lee JS, et al. Assessment of lymph node metastases using 18FFDG PET in patients with advanced gastric cancer [J]. Eur J Nucl Med Mol Imaging, 2006; 33(2): 148155.
  39. 39. Chen J, Cheong JH, Yun MJ, et al. Improvement in preoperative staging of gastric adenocarcinoma with positron emission tomography [J].Cancer, 2005; 103(11): 23832390.
  40. 40. Suttie SA, Welch AE, Park KG. Positron emission tomography for monitoring response to neoadjuvant therapy in patients with oesophageal and gastrooesophageal junction carcinoma [J]. Eur J Surg Oncol, 2009; 35(10): 10191029.
  41. 41. Yun M, Choi HS, Yoo E, et al. The role of gastric distention in differentiating recurrent tumor from physiologic uptake in the remnant stomach on 18FFDG PET [J]. J Nucl Med, 2005; 46(6): 953957.
  42. 42. Tian J, Chen L, Wei B, et al. The value of vesicant 18Ffluorodeoxyglucose positron emission tomography (18FFDG PET) in gastric malignancies [J]. Nucl Med Commun, 2004; 25(8): 825831.
  43. 43. Imperiale A, Cimarelli S, Sellem DB, et al. Focal F18 FDG uptake mimicking malignant gastric localizations disappearing after water ingestion on PET/CT images [J]. Clin Nucl Med, 2006; 31(12): 835837.
  44. 44. Zhu Z, Li F, Mao Y, et al. Improving evaluation of primary gastric malignancies by distending the stomach with milk immediately before 18FFDG PET scanning [J]. J Nucl Med Technol, 2008; 36(1): 2529.
  45. 45. Zhu Z, Li F, Zhuang H. Gastric distension by ingesting food is useful in the evaluation of primary gastric cancer by FDG PET [J]. Clin Nucl Med, 2007; 32(2): 106109.
  46. 46. Ott K, Lordick F, Herrmann K, et al. The new credo: induction chemotherapy in locally advanced gastric cancer: consequences for surgical strategies [J]. Gastric Cancer, 2008; 11(1): 19.
  47. 47. 季加孚. 胃癌外科的現(xiàn)狀與發(fā)展趨勢(shì) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(1): 13.