[A surgery-oriented classification in conversion therapy of gastric cancer]

Area of Science:

• Gastroenterology
• Surgical Oncology
• Clinical Oncology

Background:

• Advanced gastric cancer (AGC) presents diverse phenotypes, making evidence-based treatment challenging.
• Current literature on AGC treatment primarily consists of case reports and small, single-center studies.
• The emergence of new drugs and multidisciplinary teams has highlighted the potential of conversion therapy for AGC.

Purpose of the Study:

• To define advanced gastric cancer (AGC) and conversion therapy.
• To propose a novel classification system for AGC, categorizing it into resectable and unresectable stages.
• To facilitate clinical application and guide future clinical trials for AGC.

Main Methods:

• Integrating key factors like peritoneal metastasis, liver metastasis, No.16 lymph node metastasis, positive cytology, and organ infiltration (T4b) into the classification.
• Defining resectable AGC (IIII() based on R0 resection potential, further stratified by surgical risk (low-risk and high-risk).
• Classifying unresectable AGC (IIII() based on the inability to achieve R0 resection, with subtypes including conversed, partly conversed, and non-conversed after systemic therapy.

Main Results:

• A proposed classification framework for advanced gastric cancer (AGC).
• Distinction between resectable AGC (IIII() and unresectable AGC (IIII().
• Sub-classification of unresectable AGC into conversed, partly conversed, and non-conversed types post-systemic therapy.

Conclusions:

• The proposed classification aims to standardize the approach to AGC, particularly for conversion therapy.
• This framework is intended to aid in making treatment protocols, judging operational timing, and selecting surgical procedures for unresectable AGC.
• The classification seeks to improve the exploration of AGC characteristics and facilitate the launch of clinical trials.