全球主要地区胃癌诊疗指南的异同与成因解析

Analysis of the similarities, differences, and underlying causes of major global gastric cancer clinical practice guidelines

摘要:

作为全球重要的公共卫生问题，胃癌的规范化管理在部分国家和地区已逐步系统化，形成了各具特色的诊疗指南。本文系统比较了中国、日本、韩国、欧洲及美国的胃癌指南，发现尽管各指南均以循证医学为基础，但在方法学、治疗推荐、更新频率及审查机制等方面仍存在显著差异。核心差异主要体现在新辅助化疗适应证、内镜切除标准以及淋巴结清扫范围等方面，而这些差异多源自区域流行病学特征、疾病分期构成、医疗资源配置及卫生政策导向的不同。尽管如此，各指南在基础治疗理念与总体目标上呈现一致趋势，即推动诊疗标准化、提供高质量医疗、吸纳最新临床试验证据，并通过专家共识促进政策制定。本文重点介绍了各指南的构建过程、独特内容、差异特点及其形成原因。

Abstract:

As a major global public health concern, the standardized management of gastric cancer has been increasingly systematized in several countries and regions, resulting in the development of distinct clinical guidelines. This review provides a systematic comparison of gastric cancer guidelines from China, Japan, the republic of Korea, Europe, and the United States, revealing that although all guidelines adhere to the principles of evidence-based medicine, notable differences remain in methodology, therapeutic recommendations, update frequency, and review mechanisms. Key variations involve indications for neoadjuvant chemotherapy, criteria for endoscopic resection, and the extent of lymph node dissection, largely attributable to regional epidemiologic profiles, stage distribution at diagnosis, healthcare resource allocation, and health policy orientations. Nevertheless, the fundamental therapeutic principles and overarching goals of these guidelines are convergent: standardizing patient care, delivering high-quality treatment, incorporating the latest clinical trial evidence, and establishing expert consensus to inform policy-making. This review highlights how each guideline is developed, their unique elements, major differences, and the underlying reasons for these divergences.