人民卫生出版社

中国临床肿瘤学会指南工作委员会组织

1　胃癌诊断

1.1　诊断基本原则

胃癌治疗前基本诊断手段主要包括病理和影像学检查，用于胃癌的定性诊断、定位诊断和分期诊断。其他还包括体格检查、实验室检查、内镜（超声内镜和细针穿刺）、转移灶活检，以及诊断性腹腔镜探查和腹腔灌洗液评价。内镜活检组织病理学诊断是胃癌确诊和治疗的依据。胸腹盆部CT检查是治疗前分期的基本手段，MRI、腹腔镜探查及PET分别作为CT疑诊肝转移、腹膜转移及全身转移时的备选手段。影像学报告应提供涉及cTNM分期的征象描述，并给出分期意见。胃癌术后系统组织病理学诊断（pTNM分期）为明确胃癌的组织学类型、全面评估胃癌病情进展、判断患者预后、制定有针对性的个体化治疗方案提供必要的组织病理学依据。目前以肿瘤组织HER2表达状态为依据的胃癌分子分型是选择抗Her-2靶向药物治疗的依据，所有经病理诊断证实为胃或胃食管交界处腺癌的病例均有必要进行HER2检测。

1.2　影像内镜

【注释】

a.胃镜反复活检无法确定病理诊断时，腹腔积液/胸腔积液细胞学检测或转移灶的病理学检测可作为定性诊断依据。

b.通过低张、气/水充盈等手段保证胃腔的充分充盈扩张［1，2］，多期增强扫描［1］，结合多平面重组图像进行诊断［1-3］。不建议腹部CT平扫检查，如有CT增强扫描禁忌，建议MRI或EUS。

c.胸部CT可较X线平片更好地检出和显示肺部转移灶［3］。食管胃交界部癌需要判断范围及纵隔淋巴结转移情况时应行胸部CT增强扫描。

d.推荐有条件的中心开展内镜超声检查。AJCC/UICC第8版分期中EUS为cT分期的推荐手段［2］。第8版AJCC/UICC胃癌、食管癌和食管胃交界部癌分期提出了临床分期，并推荐EUS为首选分期工具。超声内镜检查不仅可直接观察病变本身，其超声探头下胃壁可分为与解剖学层次一一对应的层次，肿瘤主要表现为不均匀低回声区伴随相应胃壁结构层次的破坏，是首选的T分期工具。同时，EUS可探及胃周肿大淋巴结甚至部分肝及腹腔的转移，有助于胃癌的诊断、临床分期及评估新辅助治疗效果。系统分析显示，EUS在区分T1/2与T3/4的总敏感性和特异性分别为0.86和0.90，区分T1与T2的总敏感性和特异性分别为0.85和0.90，而区分T1a和T1b的总敏感性和特异性分别为0.87和0.75［4］。

e.腹部MRI推荐作为CT怀疑肝转移时进一步检查的手段，推荐有条件者采用肝细胞特异性造影剂，可提高肝转移诊断的敏感性［5］。

f.诊断性腹腔镜探查和腹腔灌洗液评价推荐作为CT怀疑腹膜转移时进一步检查的手段，腹腔灌洗使用约200ml生理盐水灌注至腹腔不同象限，并应回收大于50ml的灌洗液进行细胞学检查［2］。

g.根据RECIST 1.1标准［6］，肝肺或腹膜转移结节长径≥1cm或淋巴结短径≥1.5cm作为靶病灶。原发灶厚度可作为疗效评价时的参考，但不做靶病灶考量。

h.小样本研究显示，影像学功能成像参数如磁共振扩散成像ADC值［7］、能谱CT碘浓度值［8］等可辅助胃癌疗效评价，可作为不典型病例疗效评价时的参考指标。

1.3　病理学诊断

1.3.1　组织病理学诊断

组织病理学诊断(续表)

组织病理学诊断(续表)

*不能手术的晚期胃癌腹水、胸水脱落细胞学检查、远处转移病灶活检等应按照相应临床病理常规进行处理与诊断。

【注释】

a.目前国内采用内镜切除（EMR/ESD）已逐渐成为早期胃癌治疗的新选择［1-2］。EMR/SED标本应按规范的组织处理细则进行规范操作、取材、制片［3-5］。

b.第8版AJCC/UICC胃癌、食管癌和食管胃交界部癌分期（分别参见附录4.2和附录4.3）［6］对胃食管结合部（GEJ）及贲门癌分期标准的选择做出了明确的定义：对于GEJ癌，若肿瘤侵及胃食管交界线且肿瘤中心位于胃食管交界线以下≤2cm的范围内，采用食管癌分期标准，若累及胃食管交界线但其中心位于胃食管交界线以下2cm以外，以及未累及胃食管交界线的肿瘤，采用胃癌分期方法。因此，准确判断胃食管交界线的确切位置及是否受到肿瘤侵犯对于评估这一区域肿瘤至关重要（见附录4.5.1）。值得注意的是，第8版胃癌分期所采用的数据中国人群的占比很小［7］，可能会产生一定的偏移。国内关于贲门癌的单中心研究数据显示［8］，胃食管结合部癌（SiewertⅡ型贲门癌）的生物学行为及临床特点更类似于胃癌而非食管癌，但数据较小。鉴于上述国内外研究数据的差异，第8版AJCC/UICC分期中关于胃食管结合部癌临床病理分期的推荐还需要在国内临床实践中进一步通过大样本研究验证和完善，为提出适合中国人群的临床病理分期提供可靠支撑数据。

c.为避免对pTNM分期的误判，每个病例至少应评估≥16个淋巴结，若为更准确的评价，检获淋巴结数量最好>30枚［6］。为帮助临床医师准确判断淋巴结转移范围，推荐外科医生及病理医生应按照胃区域淋巴结分组标准分别进行采集、分组送检，病理报告中应分组描述，最后给出胃癌的合计“淋巴结转移数/受检淋巴结数”如xx组淋巴结：转移数/受检数。胃区域淋巴结与远处淋巴结分组标准详见附录4.5.2。

d.国家卫生计生委于2013年颁布的《胃癌规范化诊疗指南（试行）》［3］中推荐胃癌组织病理学分类参照WHO（2000版）关于胃癌的组织学分类标准（附录4.5.3），本指南推荐与国家卫生计生委相同。病理诊断困难建议提交上级医院会诊（提供原始病理报告以核对送检切片的准确，减少误差；提供充分的病变切片或蜡块以及术中所见等）。

e.Lauren分型［9］根据胃癌组织学生长方式将胃腺癌分为肠型、弥漫型、混合型。

f.第8版胃癌pTNM分期将癌组织侵犯胃固有肌层分为“T2”，但未对侵犯浅肌层、深肌层进行细致划分。国内单中心大样本临床外科病理资料的研究报道［10］，癌组织侵犯至深肌层的患者预后明显??

1.2影像内镜

1. Seevaratnam R，Cardoso R，Mcgregor C，et al. How useful is preoperative imaging for tumor，node，metastasis（TNM）staging of gastric cancer? A meta-analysis. Gastric Cancer，2012；15 Suppl 1（1）：S3-18.

2. Amin MB，Edge SB，Greene FL，et al，eds. AJCC Cancer Staging Manual. 8th ed. NewYork：Springer；2017.

3. Allum WH Blazeby JM，Griffin SM，et al. Guidelines for the management of oesophageal and gastric cancer. Gut，2011；60（11）：1449-1472.

4. Mocellin S，Pasquali S：Diagnostic accuracy of endoscopic ultrasonography（EUS）for the preoperative locoregional staging of primary gastric cancer. Cochrane Database Syst Rev 2015（2）：CD009944.

5. Kim YK，Lee MW，Lee WJ，et al. Diagnostic accuracy and sensitivity of diffusion weighted and of gadoxetic acid enhanced 3-T MR imagingalone orin combination in the detection of small liver metastasis（≤ 1.5 cm in diameter）. Invest Radiol，2012；47（3）：159-166.

6. Eisenhauer EA，Therasse P，Bogaerts J，et al. New response evaluation criteria in solid tumours：revised RECIST guideline（version 1.1）. Eur J Cancer，2009；45：228-47.

7. Giganti F，De Cobelli F，Canevari C，et al. Response to chemotherapy in gastric adenocarcinoma with diffusion-weighted MRI and（18）F-FDG-PET/CT：correlation of apparent diffusion coefficient and partial volume corrected standardized uptake value with histological tumor regression grade. J Magn Reson Imaging，2014；40（5）：1147-57.

8. Tang L，Li ZY，Li ZW，et al. Evaluating the response of gastric carcinomas to neoadjuvant chemotherapy using iodine concentration on spectral CT：a comparison with pathological regression. Clin Radiol，2015；70（11）：1198-204.

1.3.1组织病理学诊断

1. Xu G，Zhang W，Lv Y，et al. Risk factors for under-diagnosis of gastric intraepithelial neoplasia and early gastric carcinoma in endoscopic forceps biopsy in comparison with endoscopic submucosal dissection in Chinese patients. Surg Endosc，2016；30（7）：2716-22.

2. Zhou PH，Schumacher B，Yao LQ，et al. Conventional vs. water jet-assisted endoscopic submucosal dissection in early gastric cancer：a randomized controlled trial. Endoscopy，2014；46（10）：836-43.

3. 中华人民共和国卫生计划生育委员会. 《胃癌规范化诊疗指南（试行）》2013版.

4. 梁丽，张继新，戎龙，等. 80例早期胃癌及其癌前病变内镜黏膜下剥离术标本的处理及病理学评估. 中华消化内镜杂志，2016；33（9）：589-597.

5. 孙琦，樊祥山，黄勤.近端胃早期癌及其癌前病变内镜下黏膜剥离切除标本的病理学规范化检查建议.中华消化内镜杂志，2016；33（9）：585-588.

6. AJCC Cancer Staging Manual，8th ed. New York：Springer. 2016.

7. Sano T，Coit DG，Kim HH，et al. Proposal of a new stage grouping of gastric cancer for TNM classification：International Gastric Cancer Association staging project［J］. Gastric Cancer，2017；20（2）：217-225.

8. Huang Q，SunQ，FanXS，et al. Recent advances in proximal gastric cancinama［J］. J Dig Dis，2016；17（7）：421-432.

9. Lauren B. The two histological main types of gastric carcinoma：diffuse and so-called intestinal type carcinoma. An attempt at a histoclinical classification. Acta Pathol Microbiol Scand，1965；64：31-4.

10. Sun Z，Zhu GL，Lu C，et al. A novel subclassification of pT2 gastric cancers according to the depth of muscularis propria invasion：superficial muscularis propria versus deep muscularis propria/subserosa.Ann Surg，2009；249（5）：768-775.

11. NCCN Practice Guidelines in Oncology（Gastric cancer）-V4.2017（www.nccn.org）.

12. 全国胃癌病理协作组. 1477早期胃癌病例分析--（一）早期胃癌的病理分析.中华消化杂志，1990；10（5）：287-290，10（6）：341-343.

13. 薛卫成，樊祥山，孟刚整理.胃癌相关标志物免疫组化指标选择专家共识（2014）.临床与试验病理学杂志，2014；30（9）：951-953.

1.3.2分子分型

1. 中国临床肿瘤学会抗肿瘤药物安全管理专家委员会，中国抗癌协会胃癌专业委员会、肿瘤病理专业委员会. HER阳性晚期胃癌分子靶向治疗的中国专家共识（2016版）.临床肿瘤学杂志，2016；21（9）：831-839.

2. Sheng WQ，Huang D，Ying JM，et al. HER2 status in gastric cancers：a retrospective analysis from four Chinese representative clinical centers and assessment of its prognostic significance. Ann 0ncol，2013；24（9）：2360-2364.

3. Huang D，Lu N，Fan Q，et al. HER2 status in gastric and gastroesophageal junction cancer assessed by local and central laboratories：Chinese results of the HER2-EAGLE study. PLoS One，2013；8（11）：e80290.

4. Bang YJ，Van Cutsem E，Feyereislova A，et al. Trastuzumab incombination with chemotherapy versus chemotherapy alone fortreatment of HER2-positive advanced gastric and gastro-oesophagealjunction cancer（ToGA）：a phase 3，open-label，randomizedcontrolled trial. Lancet，2010；376（9742）：687-697.

5. Qiu MZ，Li Q，Wang ZQ，et al. HER2-positive patients receiving trastuzumab treatment have a comparable prognosis with HER2-negative advanced gastric cancer patients：a prospective cohort observation［J］. Int J Cancer，2014；134（10）：2468-2477.

6. Gong J，Liu T，Fan Q，et al. Optimal regimen oftrastuzumab incombination with oxaliplatin/capecitabine in first-line treatment of HER2-positive advanced gastric cancer（CGOG1001）：a multicenter，phase II trial［J］. BMC Cancer，2016；16：68.

7. Ryu MH，Yoo C，Kim JG，et al. Multicenter phaseⅡstudy oftrastuzumab in combination with capecitabine andoxaliplatin for advanced gastric cancer［J］. Eur J cancer，2015；51（4）：482-488.

8. Kim KM，Bilous M，Chu KMet al. Human epidermal growth factor receptor 2 testing in gastric cancer：recommendations of an Asia-Pacmc task force［J］. Asia Pac J clin Oncol，2014；10（4）：297-307.

9. Wang T，Hsieh ET，Henry P，et al. Matched biopsy and resectionspecimens of gastric and gastroesophageal adenocarcinoma showhighconcordance in HER2 status［J］. Hum Pathol，2014；45（5）：970-975.

10. 《胃癌HER2检测指南（2016版）》专家组.胃癌HER2检测指南（2016版）.中华病理学杂志，2016；45（8）：528-532.

11. Gomez L，Concha A，Garcia-Caballero T，et al. Assessment of HER2 status from an epidemiology study in tumor tissue samples of gastric and gastro-esophageal junction cancer：Spanish results of the HER-EAGLE study. J Clin Oncol，2012，30（Suppl）：a4089.

12. Sheng WQ，Huang D，Ying JM，et al. HER2 status in gastric cancers：a retrospective analysis from four Chinese representative clinical centers and assessment of its prognostic significance. Ann Oncol，2013，24（9）：2360-2364.

13. Qiu M，Zhou Y，Zhang X，et al. Lauren classification combined with HER2 status is a better prognostic factor in Chinese gastric cancer patients. BMC Cancer，2014，14：823.

14. Zhu L，Li Z，Wang Y，Zhang C，Liu Y，Qu XJ. Microsatellite instability and survival in gastric cancer：A systematic review and meta-analysis. Mol Clin Oncol，2015；3：699-705.

15. Smyth EC，Wotherspoon A，Peckitt C，Gonzalez D，Hulkki-Wilson S，Eltahir Z，Fassan M，Rugge M，Valeri N，Okines A，Hewish M，Allum W，Stenning S，Nankivell M，Langley R，Cunningham D. Mismatch repair deficiency，microsatellite instability，and survival. An exploratory analysis of the medical research Cuncil Adjuvant Gastric Infulsional Chemotherapy（MAGIC）trail. JAMA Oncol，2017；3（9）：1197-1203.

16. Giampieri R，Maccaroni E，Mandolesi A，et al. Mismatch repare deficiency may affect clinical outcome through immune response activation in metastatic gastric cancer patients receiving first-line chemotherapy. Gastric Cancer，2017；20：156-163.

17. Karahan B，Argon A，Y|ld| r|m M，et al. Relationship between MLH-1，MSH-2，PMS-2，MSH-6 expression and clinicopathological features in colorectal cancer［J］. Int J Clin Exp Pathol，2015；8（4）：4044-4053.

18. 秦云，梁莉萍，郑兴征，等.免疫组织化学法检测结直肠癌四种DNA错配修复蛋白表达缺失对判断肿瘤微卫星状态的价值［J］.中华病理学杂志，2015；44（10）：704-708.

19. 石迎雪，郑杰.系统筛查微卫星不稳定性结直肠癌的意义和策略［J］.中华病理学杂志，2015；44（1）：9-14.

2.1.1.1早期胃癌的内镜治疗

1. 中华人民共和国卫生计划生育委员会. 《胃癌规范化诊疗指南（试行）》2013版.

2. Kim JJ，Lee JH，Jung HY，et al. EMR for early gastric cancer in Korea：a multicenter retrospective study. Gastrointestinal endoscopy，2007，66（4）：693-700.

3. Isomoto H，Shikuwa S，Yamaguchi N，et al. Endoscopic submucosal dissection for early gastric cancer：a large-scale feasibility study. Gut，2009，58：331-336.

4. Japanese gastric cancer treatment guidelines 2014（ver. 4）. Gastric cancer：official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2016.

5. Park YM，Cho E，Kang HY，et al. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer：a systematic review and metaanalysis. Surg Endosc，2011，25：2666-2677.

6. TakizawaK，Kawata N，Tanaka M，et al. Treatment for intramucosal gastric cancer with mixed type histology（differentiated and undifferentiated）. Stomach Intest，2013，48：1567-1579.

7. Ahn JY，Jung HY，Choi KD. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer：1370 cases of absolute and extended indications. Gastrointest Endosc，2011，74：485-493.

2.1.1.2可切除胃癌的外科治疗

1. 中华人民共和国卫生计划生育委员会. 《胃癌规范化诊疗指南（试行）》2013版.

2. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014（ver. 4）. Gastric Cancer，2017，20（1）：1-19.

3. Sasako，M. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia：a randomised controlled trial. Lancet Oncol，2006，7（8）：644-651.

4. Biondi，A. Does a minimum number of 16 retrieved nodes affect survival in curatively resected gastric cancer? Eur J Surg Oncol，2015，41（6）：779-786.

5. Yamashita H，Seto Y，Sano T，et al；Japanese Gastric Cancer Association and the Japan Esophageal Society. Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer. 2017 Mar；20（Suppl 1）：69-83. doi：10. 1007/s10120-016-0663-8.

6. Zhang CH，Wu AW，Li ZY，et al. Analysis of splenic hilar lymph node metastasis in advanced gastric cancer and dissection techniques. Zhonghua Wei Chang Wai Ke Za Zhi，2011，14（8）：589-592.

7. Sasada S，Ninomiya M，Nishizaki M，et al. Frequency of lymph node metastasis to the splenic hilus and effect of splenectomy in proximal gastric cancer. Anticancer Res，2009，29（8）：3347-3351.

8. Aoyagi K，Kouhuji K，Miyagi M，et al. Prognosis of metastatic splenic hilum lymph node in patients with gastric cancer after total gastrectomy and splenectomy. World J Hepatol，2010，2（2）：81-86.

9. Sano T，Sasako M，Mizusawa J，et al. Randomized Controlled Trial to Evaluate Splenectomy in Total Gastrectomy for Proximal Gastric Carcinoma. Ann Surg，2017，265（2）：277-283.

10. Eom BW，Joo J，Kim YW，et al. Improved survival after adding dissection of the superior mesenteric vein lymph node（14v）to standard D2 gastrectomy for advanced distal gastric cancer. Surgery，2014，155：408-416.

11. Sasako，M. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med，2008，359（5）：453-462.

12. Katai H，Mizusawa J，Katayama H，et al. Short-term surgical outcomes from a phaseⅢ study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stageⅠA/ⅠB gastric cancer：Japan Clinical Oncology Group Study JCOG0912. Gastric cancer：official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2016.

13. Huscher，C. G. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer：five-year results of a randomized prospective trial. Ann Surg，2005，241（2）：232-237.

14. Kim，H. H. Long-term results of laparoscopic gastrectomy for gastric cancer：a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol，2014，32（7）：627-633.

15. Hu Y，Huang C，Sun Y，et al. Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer：A Randomized Controlled Trial. J Clin Oncol，2016，34（12）：1350-1357.

16. Kang KC. Korean Laparoscopic Gastrointestinal Surgery Study（KLASS）Group. Comparison of BillrothⅠ and Billroth Ⅱ reconstructions after laparoscopy- assisted distal gastrectomy：a retrospective analysis of large-scale multicenter results from Korea. Surg Endosc，2011，25（6）：1953-1961.

17. Shiraishi N. Gastric tube reconstruction prevented esophageal reflux after proximal gastrectomy. Gastric Cancer，1998，1（1）：78-79.

18. Souya Nunobe，Billroth 1 versus Roux-en-Y reconstructions：a quality-of-life survey at 5 year. Int J Clin Oncol，2007，12（6）：433-439.

19. 梁寒. 《胃癌根治手术写真》，天津科技翻译出版有限公司，2013年5月，ISBN：978754 3332249.

20. Fein M. Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy：a randomized trial. Ann Surg，2008，247

21. NCCN Practice Guidelines in Oncology（Gastric Cancer）-V. 5 2017（www. nccn. org）

2.1.1.2.3可切除胃癌的围术期治疗

1. Bang YJ，Kim YW，Yang HK，et al. CLASSIC trial investigators. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy（CLASSIC）：a phase 3 open-label，randomised controlled trial.Lancet，379（9813）：315-321.

2. Lee J，Lim DH，Kim S，et al. Phase Ⅲ trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection：the ARTIST trial J Clin Oncol，2012，30（3）：268-273.

3. Sasako M，Sakuramoto S，Katai H，et al. Five-year outcomes of a randomized phase Ⅲ trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage Ⅱ or Ⅲ gastric cancer. J Clin Oncol，2011，29（33）：4387-4393.

4. Macdonald JS，Smalley SR，Benedetti J，et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med，2001，345（10）：72.

5. 中华人民共和国卫生计划生育委员会. 《胃癌规范化诊疗指南（试行）》2013版.

6. Stiekema J，Trip A K，Jansen E P，et al. The prognostic significance of an R1 resection in gastric cancer patients treated with adjuvant chemoradiotherapy. Ann Surg Oncol，2014，21（4）：1107-1114.

7. Cunningham D，Allum WH，Stenning SP，et al. MAGIC Trial Participants. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med，2006，355（1）：11-20.

8. Ychou M，Boige V，Pignon JP，et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma：an FNCLCC and FFCD multicenter phaseⅢ trial. J Clin Oncol，2011，29（13）：1715-1721.

9. Sumpter K，Harper-Wynne C，Cunningham D，et al. Report of two protocol planned interim analyses in a randomised multicentre phase Ⅲ study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF. Br J Cancer，2005，92（11）：1976-1983.

10. Cunningham D1，Starling N，Rao S，et al. Upper Gastrointestinal Clinical Studies Group of the National Cancer Research Institute of the United Kingdom. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med，2008，358（1）：36-46.

11. Li ZY，Koh CE，Bu ZD，et al. Neoadjuvant chemotherapy with FOLFOX：improved outcomes in Chinese patients with locally advanced gastric cancer. J Surg Oncol，2012，105（8）：793-799.

12. Li T，Chen L. Efficacy and safety of SOX regimen as neoadjuvant chemotherapy for advanced gastric cancer. Zhonghua Wei Chang Wai Ke Za Zhi，2011，14（2）：104-106.

13. Salah-Eddin Al-Batran，et al. Perioperative chemotherapy with docetaxel，oxaliplatin，and fluorouracil/leucovorin（FLOT）versus epirubicin，cisplatin，and fluorouracil or capecitabine（ECF/ECX）for resectable gastric and EGJ cancer，ASCO 2017. Abstract 4004.

14. Stahl M，Walz M K，Stuschke M，et al. Phase Ⅲ comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction.J Clin Oncol，2009，27（6）：851-856.

15. Ajani J A，Winter K，Okawara G S，et al. Phase Ⅱ trial of preoperative chemoradiation in patients with localized gastric adenocarcinoma（RTOG 9904）：quality of combined modality therapy and pathologic response. J Clin Oncol，2006，24（24）：3953-3958.

16. Leong T，Smithers B M，Michael M，et al. TOPGEAR：a randomised phase Ⅲ trial of perioperative ECF chemotherapy versus preoperative chemoradiation plus perioperative ECF chemotherapy for resectable gastric cancer（an international，intergroup trial of the AGITG/TROG/EORTC/NCIC CTG）.BMC Cancer，2015，15：532.

17. Sarela AI，Lefkowitz R，Brennan MF，et al. Selection of patients with gastric adenocarcinoma for laparoscopic staging. Am J Surg，2006，191（1）：134-138.

2.1.2不可手术切除胃癌的综合治疗

1. van Hagen P，Hulshof MC，van Lanschot JJ，et al. 　Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012，366：2074-2084 .

2. Tepper J，Krasna MJ，Niedzwiecki D，et al. Phase III trial of trimodality therapy with cisplatin，fluorouracil，radiotherapy，and surgery compared with surgery alone for esophageal cancer：CALGB 9781. J Clin Oncol. 2008. 26（7）：1086-92.

3. Khushalani NI，Leichman CG，Proulx G，et al. Oxaliplatin in combination with protracted-infusion fluorouracil and radiation：report of a clinical trial for patients with esophageal cancer. J Clin Oncol. 2002.20（12）：2844-50.

4. Ajani JA，Mansfield PF，Crane CH，et al. Paclitaxel-based chemoradiotherapy in localized gastric carcinoma：degree of pathologic response and not clinical parameters dictated patient outcome. J Clin Oncol. 2005. 23（6）：1237-44.

5. Ajani JA，Winter K，Okawara GS，et al. PhaseⅡtrial of preoperative chemoradiation in patients with localized gastric adenocarcinoma（RTOG 9904）：quality of combined modality therapy and pathologic response. J Clin Oncol. 2006. 24（24）：3953-8.

6. Hu JB，Sun XN，Gu BX，Wang Q，Hu WX. Effect of intensity modulated radiotherapy combined with s-1-based chemotherapy in locally advanced gastric cancer patients. Oncol Res Treat. 2014. 37（1-2）：11-6.

7. Lee J，Lim dH，Kim S，et al. Phase Ⅲ trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection：the ARTIST trial. J Clin Oncol. 2012. 30（3）：268-73.

8. Inoue T，Yachida S，Usuki H，et al. Pilot feasibility study of neoadjuvant chemoradiotherapy with S-1 in patients with locally advanced gastric cancer featuring adjacent tissue invasion or JGCA bulky N2 lymph node metastases. Ann Surg Oncol. 2012. 19（9）：2937-45.

9. Wang X，Zhao DB，Jin J，et al. A Randomized Phase Ⅱ Trial of Neoadjuvant Chemotherapy Compared With Chemoradiation Therapy in Locally Advanced Gastroesophageal and Gastric Adenocarcinoma：Preliminary Results. J Radiat Oncol Biol Phys. 2016. 96（2）：Supplement 32 .

10. Ajani JA，Mansfield PF，Janjan N，et al. Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma. J Clin Oncol. 2004. 22（14）：2774-80.

11. Gastrointestinal Tumor Study Group. A comparison of combination chemotherapy and combined modality therapy for locally advanced gastric carcinoma. Cancer 1982；49：1771-1777 .

12. Gunderson LL，Hoskins RB，Cohen AC，et al. Combined modality treatment of gastric cancer. Int J Radiat Oncol Biol Phys. 1983；9（7）：965-975 .

13. Liu Y，Zhao G，Xu Y，et al. Multicenter Phase 2 Study of Peri-Irradiation Chemotherapy Plus Intensity Modulated Radiation Therapy With Concurrent Weekly Docetaxel for Inoperable or Medically Unresectable Nonmetastatic Gastric Cancer. Int J Radiat Oncol Biol Phys. 2017. 98（5）：1096-1105.

14. Moertel CG，Childs DS，Reitemeier RJ，et al. Combined 5-fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet 1969；2：865-867 .

15. Wagner AD，Grothe W，Haerting J，et al. Chemotherapy in advanced gastric cancer：a systematic review and meta-analysis based on aggregate data. J Clin Oncol 2006；24：2903-2909 .

16. Al-Batran SE，Hartmann JT，Probst S，et al. PhaseⅢ trial in metastatic gastroesophageal adenocarcinoma with fluorouracil，leucovorin plus either oxaliplatin or cisplatin：a study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol，2008，26（9）：1435-1442 .

17. Mantell BS. Radiotherapy for dysphagia due to gastric carcinoma. Br J Surg. 1982；69（2）：69-70 .

18. Coia LR，Paul AR，Engstrom PF. Combined radiation and chemotherapy as primary management of adenocarcinoma of the esophagus and gastroesophageal junction. Cancer. 1988，15；61（4）：643-649 .

19. Kim MM，Rana V，Janjan NA，et al. Clinical benefit of palliative radiation therapy in advanced gastric cancer. Acta Oncol. 2008；47（3）：421-427 .

20. Minn AY，Hsu A，La T，et al. Comparison of intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy as adjuvant therapy for gastric cancer. Cancer. 2010. 116（16）：3943-52.

21. Wang X，Li G，Zhang Y，et al. Single-arc volumetric-modulated arc therapy（sVMAT）as adjuvant treatment for gastric cancer：dosimetric comparisons with three-dimensional conformal radiotherapy（3D-CRT）and intensity-modulated radiotherapy（IMRT）. Med Dosim. 2013. 38（4）：395-400.

2.2.1晚期转移性胃癌的药物治疗选择

1. Cunningham D，Starling N，Rao S，et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med，2008，358：36-46.

2. Kang YK，Kang WK，Shin DB，et al. Capecitabine/cisplatin versus 5-fluorouracil /cisplatin as first-line therapy in patients with advanced gastric cancer：a randomized phase Ⅲ noninferiority trial. Ann Oncol，2009，20：666-673.

3. Van Cutsem E，Moiseyenko VM，Tjulandin S，et al. PhaseⅢ study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer：a report of the V325 Study Group. J Clin Oncol，2006，24：4991-4997.

4. Wang J，Xu R，Li J，et al. Randomized multicenter phase Ⅲ study of a modified docetaxel and cisplatin plus fluorouracil regimen compared with cisplatin and fluorouracil as first-line therapy for advanced or locally recurrent gastric cancer. Gastric Cancer，2016，19（1）：234-244.

5. Koizumi W，Narahara H，Hara T，et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer（SPIRITS trial）：a phase Ⅲ trial. Lancet Oncol，2008，9：215-221.

6. Ajani JA，Rodriguez W，Bodoky G，et al. Multicenter phaseⅢ comparison of cisplatin/S-1 with cisplatin/infusional fluorouracil in advanced gastric or gastro- esophageal adenocarcinoma study：the FLAGS trial. J Clin Oncol，2010，28：1547-1553.

7. Qiu MZ，Wei XL，Zhang DS，et al. Efficacy and safety of capecitabine as maintenance treatment after first-line chemotherapy using oxaliplatin and capecitabine in advanced gastric adenocarcinoma patients：a prospective observation. Tumour Biol，2014，35（5）：4369-4375.

8. Hawkes E，Okines AF，Papamichael D，et al. Docetaxel and irinotecan as second-line therapy for advanced oesophagogastric cancer. Eur J Cancer，2011，47（8）：1146-1151.

9. Hironaka S1，Ueda S，Yasui H，et al. Randomized，open-label，phase Ⅲ study comparing irinotecan with paclitaxel in patients with advanced gastric cancer without severe peritoneal metastasis after failure of prior combination chemotherapy using fluoropyrimidine plus platinum：WJOG 4007 trial. J Clin Oncol，2013，31（35）：4438-4444.

10. Bang YJ，Van Cutsem E，Feyereislova A，et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer（ToGA）：a phase3，open-label，randomized controlled trial. Lancet，2010，376：687-697.

11. HER2阳性晚期胃癌分子靶向治疗的中国专家共识（2016）. 临床肿瘤学杂志，2016，21（9）：831-839.

12. Satoh T，Xu RH，Chung HC，et al. Lapatinib plus paclitaxel versus paclitaxel alone in the second-line treatment of HER2-amplified advanced gastric cancer in Asian populations：TyTAN--a randomized，phase Ⅲ study. J Clin Oncol，2014，32（19）：2039-2049.

13. Hecht JR，Bang YJ，Qin SK，et al. Lapatinib in Combination With Capecitabine Plus Oxaliplatin in Human Epidermal Growth Factor Receptor 2-Positive Advanced or Metastatic Gastric，Esophageal，or Gastroesophageal Adenocarcinoma：TRIO-013/LOGiC-A Randomized Phase Ⅲ Trial. J Clin Oncol，2016，34（5）：443-451.

14. Kang YK，Shah MA，Ohtsu A，et al. A randomized，open-label，multicenter，adaptive phase 2/3 study of trastuzumab emtansine（T-DM1）versus a taxane（TAX）in patients（pts）with previously treated HER2-positive locally advanced or metastatic gastric/gastroesophageal junction adenocarcinoma（LA/MGC/GEJC）. J Clin Oncol，2016，34（Suppl 4）：a5.

15. Fuchs CS，Tomasek J，Yong CJ，et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma（REGARD）：an international，randomized，multicenter，placebo-controlled，phase 3 trial. Lancet. 2014，383（9911）：31-39.

16. 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，randomised phase 3 trial. Lancet Oncol，2014，15：1224-1235.

17. Li J，Qin S，Xu J，et al. Randomized，Double-Blind，Placebo- Controlled Phase Ⅲ Trial of Apatinib in Patients With Chemotherapy -Refractory Advanced or Metastatic Adenocarcinoma of the Stomach or Gastro- esophageal Junction. J Clin Oncol，2016，34（13）：1448-1454.

18. 阿帕替尼治疗胃癌的临床应用专家共识. 临床肿瘤学杂志，2015，2（9）：841-847.

19. Kang YK，Boku N，Satoh T，et al. Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to，or intolerant of，at least two previous chemotherapy regimens（ONO-4538-12，ATTRACTION-2）：a randomised，double-blind，placebo-controlled，phase 3 trial.Lancet. 2017；390（10111）：2461-2471.

20. 2017 ESMO Abstract LBA28_PR：KEYNOTE-059 Update：Efficacy and Safety of Pembrolizumab Alone or in Combination with Chemotherapy in Patients with Advanced Gastric or Gastroesophageal（G/GEJ）cancer.

21. A Study of Pembrolizumab（MK-3475）Versus Paclitaxel for Participants With Advanced Gastric/Gastroesophageal Junction Adenocarcinoma That Progressed After Therapy With Platinum and Fluoropyrimidine（MK-3475-061/KEYNOTE-061）. NCT02370498.

22. 石汉平，李苏宜，王昆华，et al. 胃癌患者营养治疗指南. 肿瘤代谢与营养电子杂志，2015（2）：37-40.

2.2.2复发或转移性胃癌单一远处转移的综合治疗

1. Niibe Y，Hayakawa K. Oligometastases and oligo-recurrence：The new era of cancer therapy. Jpn J Clin Oncol 2010；40：107-11.

2. Milano MT，Katz AW，Zhang H，Okunieff P. Oligometastases treated with stereotactic body radiotherapy：Long-term follow-up of prospective study. Int J Radiat Oncol Biol Phys 2012；83：878-86.

3. Hellman S，Weichselbaum RR. Oligometastases. J Clin Oncol 1995；13：8-10.

2.2.2.1术后局部复发或单一远处转移胃癌的治疗

1. Badgwell B，Cormier JN，Xing Y，et al. Attempted salvage resection for recurrent gastric orgastroesophageal cancer. Ann Surg Oncol. 2009 Jan；16（1）：42-50.

2. Xu C，Xie J，Liang N，et al. Concurrent involved-field radiotherapy and XELOX in gastric cancer patients with postoperative oligometastatic recurrence. J Cancer Res Ther. 2014；10 Suppl：267-71.

3. Yuan ST，Wang FL，Liu N，et al. Concurrent involved-field radiotherapy and XELOX versus XELOX chemotherapy alone in gastric cancer patients with postoperative locoregional recurrence. Am J Clin Oncol.2015；38（2）：130-4.

4. Xie J，Liang N，Qiao L，et al. Docetaxel，capecitabine and concurrent radiotherapy for gastric cancer patients with postoperative locoregional recurrence. Tumori. 2015；101（4）：433-9.

5. Shinohara T，Maeda Y，Hamada T，Futakawa N. Survival benefit of surgical treatment for liver metastases from gastric cancer. J Gastrointest Surg. 2015 Jun；19（6）：1043-51.

6. Markar SR，Mikhail S，Malietzis G，et al. Influence of Surgical Resection of Hepatic Metastases From Gastric Adenocarcinoma on Long-term Survival：Systematic Review and Pooled Analysis. Ann Surg.2016；263（6）：1092-101.

7. Zhou F，Yu XL，Liang P，et al. Microwave ablation is effective against liver metastases from gastric adenocarcinoma. Int J Hyperthermia. 2017；33（7）：830-835.

8. Hwang JE，Kim SH，Jin J，et al. Combination of percutaneous radiofrequency ablation and systemic chemotherapy are effective treatment modalities for metachronous liver metastases from gastric cancer. Clin Exp Metastasis. 2014 Jan；31（1）：25-32.

9. Oki E，Tokunaga S，Emi Y，et al. Surgical treatment of liver metastasis of gastric cancer：a retrospective multicenter cohort study（KSCC1302）. Gastric Cancer. 2016；19（3）：968-76.

10. Cho JH，Lim JY，Choi AR，et al. Comparison of Surgery Plus Chemotherapy and Palliative Chemotherapy Alone for AdvancedGastric Cancer with Krukenberg Tumor. Cancer Res Treat. 2015；47（4）：697-705.

11. Rosa F，Marrelli D，Morgagni P，et al. Krukenberg Tumors of Gastric Origin：The Rationaleof Surgical Resection and Perioperative Treatments in a Multicenter Western Experience. World J Surg.2016；40（4）：921-8.

2.2.2.2初诊Ⅳ期单一远处转移胃癌的治疗

1. Japanese Gastric CancerAssociation. Japanese classification of gastric carcinoma：3rd English edition.

2. Kodera Y，Ito S，Mochizuki Y，Ohashi N，et al. Long-term follow up of patients who were positive for peritoneal lavage cytology：final report from the CCOG0301 study. Gastric Cancer. 2012；15（3）：335-7.

3. Kano K，Aoyama T，Maezawa Y，et al. The survival and prognosticators of peritoneal cytology-positive gastric cancer patients who received upfront gastrectomy and subsequent S-1 chemotherapy. Int J Clin Oncol. 2017；22（5）：887-896.

4. Badgwell B，Blum M，Das P，et al. Phase II Trial of Laparoscopic Hyperthermic Intraperitoneal Chemoperfusion for Peritoneal Carcinomatosis or Positive Peritoneal Cytology in Patients with Gastric Adenocarcinoma. Ann Surg Oncol. 2017；24（11）：3338-3344.

5. Okabe H，Ueda S，Obama K，et al. Induction chemotherapy with S-1 plus cisplatin followed by surgery for treatment of gastric cancer with peritoneal dissemination. Ann Surg Oncol. 2009；16（12）：3227-36.

6. Yamamoto M，Kawano H，Yamaguchi S，et al. Comparison of Neoadjuvant Chemo- therapy to Surgery Followed by Adjuvant Chemotherapy in Japanese Patients with Peritoneal Lavage Cytology Positive for Gastric Carcinoma. Anticancer Res. 2015 Sep；35（9）：4859-63.

7. Masuda T，Kuramoto M，Shimada S，et al. The effect of extensive intraoperative peritoneal lavage therapy（EIPL）on stage III B + C and cytology-positive gastric cancer patients. Int J Clin Oncol. 2016；21（2）：289-94.

8. Ishigami H，Yamaguchi H，Yamashita H，et al. Surgery after intraperitoneal and systemic chemotherapy for gastric cancer with peritoneal metastasis or positive peritoneal cytology findings. Gastric Cancer. 2017；20（Suppl 1）：128-134.

9. Coccolini F，Catena F，Glehen O，et al. Effect of intraperitoneal chemotherapy and peritoneal lavage in positive peritoneal cytology in gastric cancer. Systematic review and meta-analysis. Eur J Surg Oncol.2016；42（9）：1261-7.

10. Satoh S，Okabe H，Teramukai S，et al. Phase II trial of combined treatment consisting of preoperative S-1 plus cisplatin followed by gastrectomy and postoperative S-1 for stage IV gastric cancer. Gastric Cancer.2012；15（1）：61-9.

11. Tsuburaya A，Mizusawa J，Tanaka Y，et al. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg. 2014；101（6）：653-60.

12. Ito S，Sano T，Mizusawa J，et al. A phase II study of preoperative chemotherapy with docetaxel，cisplatin，and S-1 followed by gastrectomy with D2 plus para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis：JCOG1002. Gastric Cancer. 2017；20（2）：322-331.

13. Wang Y，Yu YY，Li W，et al. A phase II trial of Xeloda and oxaliplatin（XELOX）neo-adjuvant chemotherapy followed bysurgery for advanced gastric cancer patients with para-aortic lymph node metastasis. Cancer Chemother Pharmacol. 2014；73（6）：1155-61.

14. Fujitani K， Yang HK， Mizusawa J， et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor（REGATTA）：phase 3，randomised controlled trial. Lancet Oncol. 2016；17（3）：309- 18.

15. Chen J，Tang Z，Dong X，et al. Radiofrequency ablation for liver metastasis from gastric cancer. Eur J Surg Oncol. 2013 Jul；39（7）：701-6.

16. Guner A，Son T，Cho I，et al. Liver-directed treatments for liver metastasis from gastric adenocarcinoma：comparison between liver resection and radiofrequency ablation. Gastric Cancer. 2016；19（3）：951-60.

17. Markar SR，Mackenzie H，Mikhail S，et al. Surgical resection of hepatic metastases from gastric cancer：outcomes from national series in England. Gastric Cancer. 2017；20（2）：379-386.

18. Petrelli F，Coinu A，Cabiddu M，et al. Hepatic resection for gastric cancer liver metastases：A systematic review and meta-analysis. J Surg Oncol. 2015；111（8）：1021 -7.

19. Markar SR，Mikhail S，Malietzis G，et al. Influence of Surgical Resection of Hepatic Metastases From Gastric Adenocarcinoma on Long-term Survival：Systematic Review and Pooled Analysis. Ann Surg.2016；263（6）：1092-101.

20. Liao YY，Peng NF，Long D，et al. Hepatectomy for liver metastases from gastric cancer：a systematic review. BMC Surg. 2017；17（1）：14.

21. Kataoka K，Kinoshita T，Moehler M，et al. Current management of liver metastases from gastric cancer：what is common practice New challenge of EORTC and JCOG. Gastric Cancer. 2017 Sep；20（5）：904-912.

22. Tiberio GA，Baiocchi GL，Morgagni P，et al. Gastric cancer and synchronous hepatic metastases：is it possible to recognize candidates to R0 resection?Ann Surg Oncol. 2015；22（2）：589-96.

23. Tiberio GA，Ministrini S，Gardini A，et al. Factors influencing survival after hepatectomy for metastases fromgastric cancer. Eur J Surg Oncol. 2016；42（8）：1229 -35.

24. Jiang H，Li Q，Yu S，et al. Impact of HER2 expression on outcome in gastric cancer patients withliver metastasis. Clin Transl Oncol. 2017；19（2）：197-203.

25. Brieau B，Auzolle C，Pozet A，et al. Efficacy of modern chemotherapy and prognostic factors in patients with ovarian metastases from gastric cancer：A retrospective AGEO multicentrestudy. Dig Liver Dis.2016；48（4）：441-5.

26. Cho JH，Lim JY，Choi AR，et al. Comparison of surgery plus chemotherapy and palliative chemotherapy alone for advanced gastric cancer with Krukenberg tumor. Cancer Res Treat. 2015；47（4）：697-705.

3.随访

1. Smyth EC，Verheij M，Allum W，et al. Gastric cancer：ESMO Clinical Practice Guidelines for diagnosis，treatment and follow-up. ANN ONCOL 2016；27（suppl 5）：v38-49.

2. Ajani JA，D'Amico TA，Almhanna K，et al. Gastric Cancer，Version 3. 2016，NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2016；14（10）：1286-1312.

3. Ajani JA，D'Amico TA，et al. Gastric Cancer，Version 5. 2017，NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2017.

4. Japanese gastric cancer treatment guidelines 2014（ver. 4）. GASTRIC CANCER 2016.

4.附录

1. Seevaratnam R，Cardoso R，Mcgregor C，et al. How useful is preoperative imaging for tumor，node，metastasis（TNM）staging of gastric cancer? A meta-analysis. Gastric Cancer，2012，15 Suppl 1（1）：S3-18.

2. Kumano S，Murakami T，Kim T，et al. T staging of gastric cancer：role of multi-detector row CT.Radiology. 2005，237（3）：961-966.

3. Kim JW，Shin SS，Heo SH，et al. Diagnostic performance of 64-section CT using CT gastrography in preoperative T staging of gastric cancer according to 7th edition of AJCC cancer staging manual. Eur Radiol，2012，22（3）：654-662.

4. Hasegawa S，Yoshikawa T，Shirai J，et al. A prospective validation study to diagnose serosalinvasionand nodal metastases of gastric cancer by multidetector- row CT. Ann SurgOncol. 2013；20（6）：2016-2022.

5. Habermann CR，Weiss F，Riecken R，et al. Preoperative stagingof gastric adeno- carcinoma：comparison of helical CT and endoscopicUS. Radiology. 2004；230（2）：465-471.

6. Kim TU，Kim S，Lee JW，et al. MDCT features in the differentiation of T4a gastric cancerfrom lessadvanced gastric cancer：significance of the hyper- attenuating serosa sign. Br J Radiol. 2013；86（1029）：20130290.

7. Lee SL，Ku YM，Jeon HM，et al. Impact of the cross-sectional location of multidetector computed tomography scans on prediction of serosalexposurein patients with advanced gastric cancer. Ann SurgOncol.2017；24（4）：1003-1009.

8. Amin MB，Edge SB，Greene FL，et al，eds. AJCC Cancer Staging Manual. 8th ed. NewYork：Springer；2017.

9. Fukuya T，Honda H，Hayashi T，et al. Lymphnode metastases：efficacy for detection with helical CT in patients with gastric cancer. Radiology. 1995；197（3）：705-711.

10. Robert MK，Thomas CK. Imaging in assessing lymph node status in gastric cancer. Gastric Cancer.2009；12：6-22.

11. 日本胃部学会. 胃癌取扱い规约（第14版）［M］. 金原出版株式会社，2010.