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    Home > Active Ingredient News > Digestive System Information > Topic Written Talk | Professor Zhao Changlin and Xu Huimian: Progress in comprehensive treatment of advanced gastric cancer (1)

    Topic Written Talk | Professor Zhao Changlin and Xu Huimian: Progress in comprehensive treatment of advanced gastric cancer (1)

    • Last Update: 2021-03-23
    • Source: Internet
    • Author: User
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    Author: Reading the Idea of Dalian University Affiliated Xinhua Hospital XU Hui Mian China Medical University First Affiliated Hospital of the preamble to the latest data show that the global number of annual new cases of stomach cancer about 100 million, while Chinese gastric cancer incidence and mortality are accounted for about 50% of the world, topped Bit.

    According to the "2015 China Cancer Incidence and Mortality Statistics" released by the Hejie Academician of the National Cancer Center recently, the incidence and mortality of gastric cancer in China rank third.

    The analysis of cancer incidence and mortality trends in China from 2000 to 2015 shows that although the incidence and mortality of gastric cancer in China are on a downward trend, the situation is still severe.
    The 5-year survival rate of gastric cancer in China is still hovering at about 30%, which is the same as that of East Asian countries with a high incidence of gastric cancer.
    Compared with Japan and South Korea, the gap is significant.

    The reason is that about 70% of patients are late for treatment, and they are already in advanced gastric cancer at the time of diagnosis.

    In recent years, new progress has been made in the comprehensive treatment of advanced gastric cancer.
    The 2020 version of the Chinese Society of Clinical Oncology (CSCO) Guidelines for the Diagnosis and Treatment of Gastric Cancer (hereinafter referred to as the "Guide") has always run through the concepts and strategies of comprehensive treatment of gastric cancer.

    At present, comprehensive treatment of advanced gastric cancer mainly includes preoperative treatment (including neoadjuvant therapy and conversion therapy), surgery, adjuvant chemotherapy, radiotherapy, targeted drug therapy and immunotherapy.

    This article combines the new version of the guidelines and high-level evidence from domestic and foreign gastric cancer clinical studies in recent years, focusing on the progress of comprehensive treatment of advanced resectable gastric cancer.

    1.
    Connotation of advanced gastric cancer.
    Advanced gastric cancer refers to the depth of tumor invasion beyond the submucosa, and can infiltrate into the muscle layer, serosal layer, and even penetrate the serous membrane to invade surrounding tissues or organs.According to imaging endoscopy, histopathology, molecular classification, TNM staging, and surgical evaluation, the guidelines divide advanced gastric cancer into advanced resectable gastric cancer (T2N1~2M0, T3N0~1M0, T4N0M0, T2N3M0, T3N2~3M0, T4aN1 ~3M0, T4bNanyM0, no other unresectable factors), advanced unresectable gastric cancer, including potentially resectable gastric cancer (T2~4bNanyM0, with severe invasion of the primary tumor, unable to separate from surrounding normal tissues or surrounding large blood vessels; regional lymph nodes Fixed, fused into a cluster, or there are contraindications to surgery, etc.
    ), advanced human epidermal growth factor receptor-2 (HER2) negative gastric cancer, advanced HER2-positive gastric cancer, advanced low-grade microsatellite instability (MSI-L)/ Microsatellite stable (MSS) gastric cancer, advanced advanced microsatellite unstable (MSI-H) gastric cancer.

    It can be said that advanced gastric cancer is the general term for gastric cancer that covers T2N1M0~4bNanyM0.
    It has the characteristics of different clinical manifestations, different heterogeneity, diverse molecular types, and different biological behaviors of tumors.
    The treatment effect is still not satisfactory and the prognosis is poor.
    , Easy to relapse and metastasize.

    At present, a preliminary consensus has been reached in gastric cancer surgery: surgical operation alone cannot achieve a radical cure in the biological sense, even if the scope of resection and lymph node dissection is expanded.

    Therefore, multidisciplinary comprehensive treatment is required.

     2.
    Comprehensive treatment of advanced resectable gastric cancer 2.
    1 Neoadjuvant chemotherapy combined with surgical surgery is currently the only possible cure for gastric cancer, but for advanced gastric cancer, only surgery is often accompanied by a high risk of postoperative recurrence, and the prognosis of patients is poor.

    In theory, neoadjuvant therapy can shrink tumors, downgrade tumors, increase R0 resection rates and complete pathological remission (pCR) rates, control micrometastases, reduce postoperative recurrence and metastasis, and benefit patients' long-term survival.

    After the Japanese-led distal radical gastric cancer surgery (D2) was recognized by the Eastern and Western medical circles, the research hotspot of gastric cancer surgical treatment has gradually developed in the direction of multidisciplinary standardized comprehensive treatment.

    In the research of gastric cancer or esophagogastric junction adenocarcinoma, neoadjuvant therapy can downgrade tumors, increase R0 resection rate and pCR rate, and can treat micrometastasis well, and can verify the effectiveness and safety of chemotherapy regimens.

    The primary target of neoadjuvant chemotherapy is those patients with advanced gastric cancer whose R0 resection is difficult or the prognosis is poor.
    Clinical trials have shown that for patients with advanced resectable gastric cancer, adding neoadjuvant chemotherapy can significantly improve survival and reduce the risk of recurrence.

     The British MAGIC study established the status of perioperative chemotherapy in the treatment of advanced gastric cancer.

    As a result, 3 cycles of ECF before surgery + surgery + 3 cycles of ECF adjuvant chemotherapy after surgery have become the standard treatment for advanced resectable gastric cancer in Europe.

    The 2017 ASCO annual meeting reported the German FLOT4 Phase III clinical study.
    The purpose of the study was to compare the ECF (epirubicin, cisplatin, fluorouracil) three-drug regimen in the MAGIC study with the three-drug regimen in the FLOT4 study for advanced resectable gastric cancer.
    The survival benefit of the regimen (docetaxel, oxaliplatin, fluorouracil).

    The results showed that compared with the ECF regimen, the FLOT4 regimen significantly improved the cure rate of surgery.
    The median survival time of the FLOT4 regimen (OS, 50 months vs.
    35 months) and median progression-free survival (PFS, 30 months) vs 18 months) are significantly better than the ECF program.

    As a result, the FLOT4 regimen has become the new preoperative treatment standard for advanced resectable gastric cancer and esophagogastric junction cancer in Europe, replacing the ECF regimen for many years, and has become the first choice for neoadjuvant chemotherapy in Europe.

     The 2019 ESMO Annual Meeting South Korea announced the results of the PRODIGY study, suggesting that neoadjuvant chemotherapy + D2 surgery + adjuvant chemotherapy can be considered for advanced resectable gastric cancer.

    Figure 1 Evidence source of neoadjuvant chemotherapy: South Korea's PRODIGY study.
    This study enrolled 530 patients with advanced gastric cancer or esophagogastric junction adenocarcinoma whose clinical stage was cT2~3/N+M0 or cT4/NanyM0, PS 0~ 1.

    A total of 484 patients completed a 3-year follow-up, of which the neoadjuvant chemotherapy group (CSC: 238) received 3 cycles of neoadjuvant chemotherapy (docetaxel + oxaliplatin + S-1) before surgery, and then D2 surgery , S-1 adjuvant chemotherapy after surgery; the adjuvant chemotherapy group (SC: 246 cases) received direct D2 surgery and S-1 adjuvant chemotherapy.

    The primary endpoint was the 3-year PFS rate.

    The results showed that the R0 resection rate was 96.
    4% and 85.
    8% in the neoadjuvant chemotherapy group and adjuvant chemotherapy group, respectively (p<0.
    0001); 23 patients in the neoadjuvant chemotherapy group had pCR (10.
    4%); the neoadjuvant chemotherapy group and the adjuvant chemotherapy group were 3 years The PFS rates were 66.
    3% and 60.
    2% (HR: 0.
    70, P=0.
    023).

    The neoadjuvant chemotherapy group was significantly better than the adjuvant chemotherapy group in terms of tumor downstage, R0 resection rate, and improvement of PFS, and the safety was acceptable.

     The 2020 ASCO GI Conference China announced the preliminary results of the RESONANCE multi-center study.

    Figure 2 Evidence source of neoadjuvant chemotherapy: From September 2012 to July 2019 in the Chinese RESONANCE study, the study included stages Ⅱ to Ⅲ (AJCC seventh edition staging) and histologically confirmed gastric cancer or esophagogastric junction 772 patients with adenocarcinoma and surgical resection were randomly divided into neoadjuvant therapy group (preoperative SOX 2 to 4 cycles + D2 surgery + postoperative SOX to 8 cycles) and adjuvant therapy group (D2 surgery + postoperative SOX 8 cycles) .

    The primary endpoint of the study was 3-year disease-free survival (DFS); the secondary endpoints were 5-year OS, response rate (RR), R0 resection rate, and safety.

    The results showed that the tumor downgrading rate in the neoadjuvant treatment group was 67.
    6% (261/386); the neoadjuvant treatment group significantly increased the R0 resection rate compared with the adjuvant treatment group (94.
    8% vs 83.
    8%, P<0.
    001); the neoadjuvant treatment group The pathological effective rate and pCR rate were 67.
    5% and 23.
    6%, respectively.

    There was no significant difference between the two groups in terms of operation time, blood loss, postoperative complications, and length of stay.

    It is concluded that SOX neoadjuvant chemotherapy increases the R0 resection rate, has acceptable side effects, has good safety, and has no effect on sequential surgery.

    SOX perioperative chemotherapy can prolong DFS and OS.

     Regarding the optimal plan of neoadjuvant chemotherapy and the number of chemotherapy cycles, there is still a problem to be solved that has not yet reached a consensus.

    Due to differences in tumor location and tumor biological behavior, the proportion of esophagogastric junction cancer in Asian patient populations is lower than in Europe and the United States.

    Therefore, neoadjuvant chemotherapy should be selected according to different regions, tumor locations and tumor biological behaviors, and the number of chemotherapy cycles should be determined.

    The current consensus is that the FLOT4 regimen is the preferred regimen for neoadjuvant chemotherapy in Europe and the United States; studies in China and South Korea show that the SOX regimen and the DOS regimen can significantly increase the R0 resection rate and pCR rate, with good safety, and suitable for Asian patients with advanced resectable gastric cancer.

    The COMPASS-D study compared the 2-cycle and 4-cycle cisplatin/S-1 regimen with the DCS regimen.

    The results showed that cisplatin/S-1 regimen 4 cycles and DCS regimen 3 cycles showed no advantages in pCR rate and R0 resection rate compared with cisplatin/S-1 regimen 2 cycles.

    Therefore, it is reasonable to propose that the number of cycles of neoadjuvant chemotherapy is 2 to 4 cycles.
    Whether patients with more than 4 cycles will benefit more remains to be confirmed by further studies.

     2.
    2 Neoadjuvant chemoradiation combined with surgery Neoadjuvant chemoradiation + D2 surgery The current recommended indication is stage III esophagogastric junction cancer.
    Preoperative simultaneous radiotherapy and chemotherapy include both local and systemic treatments, which theoretically can provide better curative effects.
    In order to achieve tumor downgrading, increase the R0 resection rate and improve the overall survival effect, and will not increase postoperative complications and mortality.

    US RTOG9904 is a phase II single-arm clinical study.

    The study included patients with advanced gastric adenocarcinoma or esophagogastric junction adenocarcinoma with preoperative staging of cT2-3N1/N0M0 or cT1N1M0.

    The patient received PLF (fluorouracil, leucovorin, cisplatin) before surgery and received 2 cycles of neoadjuvant chemotherapy followed by concurrent radiotherapy and chemotherapy (continuous intravenous infusion of fluorouracil + weekly paclitaxel infusion).

    The results showed that the R0 resection rates of D2 surgery in 49 patients were 50% and 77%, the pCR rate was up to 26%, and the 1-year survival rate was 82% and 69%, respectively.

    Adverse effects of treatment can be tolerated.

    Studies have preliminarily confirmed that neoadjuvant radiotherapy and chemotherapy can not only downgrade the primary tumor, increase the R0 resection rate and pCR rate, and improve the survival rate of patients, but also has good safety.

     The MD Anderson Cancer Center in the United States conducted a prospective phase II study, and the results showed that the R0 resection rate of patients receiving concurrent preoperative radiotherapy and chemotherapy was 70% to 80%, and the pCR rate was 20% to 30%.

    In a prospective study conducted by the National Cancer Center of China, the R0 resection rate in the preoperative concurrent radiotherapy and chemotherapy group was 81.
    8%, and the pCR rate was 17.
    4%.

    The Cancer Hospital of Fudan University conducted a Phase II clinical study of neoadjuvant radiotherapy and chemotherapy for advanced gastric cancer (NCT02024217) from 2012 to 2014.

    A total of 40 patients with gastric cancer or gastroesophageal junction adenocarcinoma with cT4aN﹢M0 or cT4bNxM0 were enrolled in the study.
    Among them, 36 patients completed neoadjuvant chemoradiotherapy, the R0 resection rate was 67%, and the pCR rate was 13.
    9%.

    The treatment toxicity is within the acceptable range.

     In 2019, ASCO GI released the interim analysis results of the TOPGEAR study.

    The study is an international multi-center phase III randomized controlled clinical trial.

    The purpose of the study was to evaluate the superiority of neoadjuvant radiotherapy combined with perioperative ECF chemotherapy in advanced gastric cancer compared with perioperative ECF chemotherapy, and it is still being enrolled in the group.

    Interim analysis results of 120 patients enrolled in the study: the completion rate of neoadjuvant chemotherapy and neoadjuvant chemotherapy group received preoperative chemotherapy (98% vs 93%) and postoperative adjuvant chemotherapy (53% vs 65%) Statistical difference.

    There was no difference in adverse reactions between the two groups (52% vs 50%).

    There was no statistically significant difference in surgical complications above grade 3 (including anastomotic leakage and abdominal infection) between the two groups (22% vs 22%).

    The results of the interim analysis showed that neoadjuvant radiotherapy and chemotherapy did not increase the incidence of obvious treatment toxicity and surgical complications, and could be tolerated by more advanced gastric cancer patients.

     Currently, the Sun Yat-sen University Cancer Center's multi-center phase III randomized controlled clinical trial (Neo-CRAG) for preoperative radiochemotherapy versus preoperative chemotherapy for advanced gastric cancer is ongoing.

    The Cancer Hospital of Fudan University is also conducting a phase III study (PREACT study, NCT03013010) of preoperative radiochemotherapy versus preoperative chemotherapy for advanced gastric cancer.

    It is expected that the TOPGEAR study and the results of these two phase III clinical studies can provide new evidence for exploring the best comprehensive treatment strategy for advanced resectable gastric cancer.

    2.
    3 Neoadjuvant chemotherapy combined with targeted therapy In the perioperative treatment of advanced gastric cancer, in addition to traditional neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy, targeted drugs are also included in neoadjuvant therapy.

    For HER2-positive advanced gastric cancer, the current phase II clinical study shows that trastuzumab combined with neoadjuvant chemotherapy is very effective.

    Up to now, different neoadjuvant chemotherapy combined with targeted drugs have emerged: trastuzumab (anti-HER2), ramucirumab (Ramucirumab) are vascular endothelial growth factor receptor 2 (VEGFR-2) antagonists Drugs, apatinib (anti-VEGFR-2), cetuximab (anti-epidermal growth factor receptor).

    Whether the neoadjuvant chemotherapy combined with targeted drugs for advanced gastric cancer can further improve the efficacy and long-term survival of patients with advanced gastric cancer is worthy of in-depth discussion.

    2.
    4 The correlation between neoadjuvant or adjuvant chemotherapy and immunotherapy in patients with PD-L1 positive gastric cancer and the efficacy of immunotherapy has also been reported, but it is not yet clear.

    The efficacy of immunotherapy in the perioperative period (neo-adjuvant or adjuvant therapy) for advanced resectable gastric cancer is being explored.

    The KEYNOTE-585 study released by the European Society of Medical Oncology (ESMO ASIA) in 2019 evaluated pembrolizumab (PD-1 humanized monoclonal antibody) combined with chemotherapy XP regimen (cisplatin/capecitabine) Or FP regimen (cisplatin/5-FU) compared with pembrolizumab + placebo in the perioperative treatment of gastric cancer and esophagogastric junction cancer.

    At present, there are corresponding clinical trials in the group (NCT03631615, NCT03221426), and the research results are worth looking forward to.

    For cT3-4aN+M0, stage cⅢ MSI-H/mismatch repair gene defect (dMMR) resectable gastric cancer and esophagogastric junction cancer, select immune checkpoint inhibitor (PD-1/PD-L1) combination before surgery Whether neoadjuvant chemoradiation or neoadjuvant chemotherapy can further improve the efficacy and long-term survival of patients is worth exploring.

    In addition, studies have shown that EB virus (epstein-barr virus, EBV), also known as Human herpesvirus 4 (HHV-4) positive gastric cancer patients may be highly sensitive to immunotherapy, and EBV may predict the efficacy of immunotherapy for gastric cancer.
    Potential molecular biomarkers.

    There are still many directions for future advanced gastric cancer immunotherapy, but gastric cancer immunotherapy requires more precise selection of dominant populations and precise positioning.

    Therefore, the exploration of molecular biomarkers is essential .
    the
    former 3.
    comprehensive treatment of gastric cancer patients should be clearly MSI / MMR and HER2 status NCCN (in 2020 V1 version) gastric updated guideline biggest bright spot: microsatellite instability (MSI), mismatch repair genes (MMR) is detected and defined.

    Both gastric cancer biopsy specimens and surgical specimens are suitable for MSI/MMR detection.
    It is
    recommended that for newly diagnosed gastric cancer patients, when the ECOG score is less than 2 points, polymerase chain reaction (PCR) detection MSI should be performed to determine MSI-H, MSS, MSI- L, or detect MMR by immunohistochemistry (IHC) to determine dMMR and mismatch repair gene soundness (pMMR) to assess the MSI/MMR status of gastric cancer patients.

    The coincidence rate of IHC detection MMR and PCR detection MSI results is high, close to 97 %~100%.

    Therefore, MSS/MSI-L is equivalent to pMMR and is an index for predicting the efficacy of chemotherapy; and MSI-H is equivalent to dMMR, which is a biomarker for immunotherapy.

     Due to the specific biological behavior of MSI-H/dMMR tumors, patients with MSI-H/dMMR have a better prognosis than patients with MSS/MSI-L/pMMR, but patients with MSI-H/dMMR are resistant to fluorouracils and other chemotherapeutics.
    Insensitive, not only can not benefit from chemotherapy, but will increase the toxicity of chemotherapy.

    Therefore, before the proposed neoadjuvant treatment of fluorouracil or paclitaxel-based chemotherapy, whether it is patients with advanced resectable/unresectable gastric cancer, or recurrent or advanced metastatic gastric cancer, patients with gastric cancer should be identified before comprehensive treatment Whether it is MSS/MSI-L/pMMR gastric cancer or MSI-H/dMMR gastric cancer, we can accurately guide the comprehensive treatment of gastric cancer based on this.

    A Mata analysis published in 2019 showed that chemotherapy + surgery for MSS/MSI-L advanced gastric cancer patients benefited from both DFS and OS compared with surgery alone, while patients with advanced gastric cancer MSI-H gastric cancer were not sensitive to chemotherapy and simple The prognosis of surgery is better.

    Figure 3 2019 Mata analysis: MSS-type advanced gastric cancer chemotherapy + surgery benefit advanced MSI-H-type gastric cancer chemotherapy does not benefit HER2-positive gastric cancer is a unique subtype that requires different comprehensive treatment strategies.

    The level of HER2 amplification can be used to predict the sensitivity and survival benefit of advanced gastric cancer to trastuzumab treatment.

    Both gastric cancer biopsy specimens and surgical specimens are suitable for HER2 detection.

    For patients considering chemotherapy combined with trastuzumab for HER2-positive advanced resectable/potentially resectable/unresectable gastric cancer, IHC and fluorescent in situ hybridization (FISH) or other in situ hybridization (ISH) are recommended to assess HER2 overexpression Or the level of amplification.

    4.
    New adjuvant treatment strategies for advanced resectable gastric cancer CSCO (2020 edition) guidelines for gastric cancer have updated the treatment of advanced resectable gastric cancer.

    Figure 4 The 2020 version of the CSCO guidelines for neoadjuvant treatment strategies for advanced resectable gastric cancer.
    In the process of neoadjuvant treatment, timely evaluation of curative effect is emphasized, but the curative effect evaluation criteria of neoadjuvant treatment and the grasp of the timing of surgery are worthy of further discussion. Patients with advanced resectable gastric cancer after neoadjuvant therapy, including patients with pCR confirmed by surgical specimens, are still recommended for adjuvant chemotherapy according to the original regimen.

    The high-level new evidence on adjuvant chemotherapy will be detailed in the progress of comprehensive treatment of advanced gastric cancer (2).

     5.
    Summary Take a look at the high-quality evidence obtained in clinical studies and trials of neoadjuvant therapy for advanced resectable gastric cancer in Europe, America, China, Japan and South Korea, and compare the NCCN guidelines, ESMO guidelines, Japan (JGCA) guidelines 5th edition, and South Korea guidelines horizontally.
    After the 2019 edition, we can fully understand the similarities and differences in comprehensive treatment strategies for advanced resectable gastric cancer in Europe, America, China, Japan and Korea.

    The NCCN guidelines recommend neoadjuvant chemotherapy or radiochemotherapy for advanced resectable gastric cancer of cT2N0-3M0; ESMO guidelines recommend perioperative chemotherapy of cisplatin/fluorouracil regimen for all advanced resectable gastric cancers> cT2N0M0; Japanese and Korean guidelines suggest that For advanced resectable gastric cancer, D2 surgery + adjuvant chemotherapy is recommended; the Chinese CSCO Guide 2020 version recommends neoadjuvant chemotherapy for cT3-4aN+M0, cⅢ stage resectable gastric cancer, and for cT3-4aN+M0, cⅢ stage resectable For esophagogastric junction cancer, neoadjuvant chemoradiation or neoadjuvant chemotherapy (PLOT4) is recommended.

     The author believes that most of the high-level evidence in the new Chinese guidelines comes from foreign research institutions such as Europe and the United States, and it still needs to be clinically verified in China.

    For cT2-3N0-2M0, cIB-ⅡA stage resectable gastric cancer, the standard mode of D2 surgery + adjuvant chemotherapy should be recommended, while for cT3-4aN+M0, cⅢ stage resectable gastric cancer, D2 surgery + perioperative chemotherapy is recommended.
    cT3-4aN+M0, cⅢ stage resectable esophagogastric junction cancer recommends neoadjuvant chemoradiation + D2 surgery + adjuvant chemotherapy, which needs further exploration.

    MSI-H resectable gastric cancer is not sensitive to chemotherapy, and D2 surgery alone has a better prognosis.
    Patients of this type should be screened before comprehensive treatment.

    In short, a number of clinical studies on comprehensive treatment of advanced gastric cancer are being actively carried out in China, and it is hoped that the results of the study will add new high-level evidence to the update of the Chinese version of the guidelines.

     The progress of comprehensive treatment of advanced gastric cancer (2) will be released in the near future, please read it.

    Professor Zhao Changlin, Chief Physician, Doctor of Medicine, and Master's Supervisor Director of the Department of Gastrointestinal Oncology, Xinhua Hospital Affiliated to Dalian University, Head of the Dalian Colon and Rectal Cancer Diagnosis and Treatment Base, Member of the Standing Committee of the Liaoning Colorectal Cancer Professional Committee of the Chinese Anti-Cancer Association Chinese Anti-Cancer Association Liaoning Gastric Cancer Professional Committee Member of the Standing Committee of the Abdominal Tumor Committee of the Chinese Medical Education Association Member of the Standing Committee of the Liaoning Base Standing Committee of the Liaoning Provincial Tumor Marker Professional Committee Member of the Standing Committee of the Liaoning Provincial Tumor Biology and Targeted Therapy Professional Committee Member of the Liaoning Provincial Chemotherapy Professional Committee Member of the Chinese Medical Association Liaoning Provincial Oncology Branch Eighth, Member of the Ninth Committee Chinese General Surgery Literature (Electronic Edition) Editorial Board Member of the Chinese Electronic Journal of Colorectal Diseases Special Expert Reviewer, National Natural Science Foundation of China Project Reviewer, National Health Commission Science and Technology Project Reviewer, National Ministry of Education Science and Technology Project Reviewer, Professor Xu Huimian National Second-level Professor, Special Allowance Expert of the State Council, Doctoral Supervisor, Visiting Professor of Dalian University, Director of the Cancer Center of the First Affiliated Hospital of China Medical University.
    Director of the Oncology Branch of the Chinese Medical University.
    Consultation experts with academic positions in the Central Health Commission have long been committed to exploring the law of tumor metastasis and optimizing clinical standardized diagnosis and treatment, and have made outstanding contributions to improving the level of tumor prevention and treatment in our province and even the country.
    Won the 10th Chinese Physician Award and Outstanding Expert of the Liaoning Provincial Government , The first Liaoning famous doctor and other honorary titles successively presided over and undertook to publish 161 domestic core journal papers and 93 papers included in SCI according to the natural science fund projects and 19 national, provincial and ministerial scientific research projects such as "863" and "973".
    Two monographs on gastric cancer with an impact factor of more than 300 points.
    In 2001 and 2006, two monographs on gastric cancer won the second prize of the National Science and Technology Progress Award and a number of provincial and ministerial science and technology progress awards.
    Recommended reading 1.
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    Professor Zhao Changlin: "Same function but different effect" APOLLO study is the dynamic monitoring of ctDNA liquid biopsy for drug-resistant advanced tumor patients.
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