最新中国临床肿瘤学会、美国国立综合癌症网络和欧洲肿瘤内科学会胃癌诊疗指南的对比解读OA

Gastric cancer remains a major global malignancy and poses a particularly heavy disease burden in China.Rapid advances in molecular pathology have incorporated key biomarkers,including human epidermal growth factor receptor 2(HER2),mismatch repair/microsatellite instability(MMR/MSI),programmed death-ligand 1(PD-L1),and claudin 18.2(CLDN18.2),into routine clinical practice,promoting the accelerated development of targeted therapy and immunotherapy,and advancing the diagnosis and treatment of gastric can-cer into an era of precision medicine.Against this background,gastric cancer guidelines have been continuously updated across different regions,based on varying evidence systems,disease spectra,and drug accessibility,leading to differences and similarities in their recom-mendations.This article compares the most recent versions of three widely used gastric cancer guidelines available as of December 2025,including the Chinese Society of Clinical Oncology(CSCO)guidelines(2025 edition),the National Comprehensive Cancer Network(NCCN)guidelines(version 1.2026),and the European Society for Medical Oncology(ESMO)gastric cancer living guidelines(version 1.4,updated in September 2024),and summarizes their major consensus and differences in biomarker testing strategies,perioperative management,and systemic therapy for advanced gastric cancer.Overall,the three guidelines are broadly consistent regarding stratification based on key bio-markers including HER2,MMR/MSI,PD-L1,and CLDN18.2,and fluoropyrimidine-platinum chemotherapy backbones.Key differences involve the scope and prioritization of biomarker testing,the selection of perioperative regimens,the concept of conversion therapy,and the positioning of immunotherapy and targeted agents,reflecting regional variations in population characteristics,evidence bases and drug accessibility.A clear understanding of these similarities and differences may support individualized treatment selection and inform clinical decision making.