The incidence of gastric cancer (GC) is expected to increase to 1.77 million cases by 2040. To improve treatment outcomes, GC patients are increasingly treated with neoadjuvant chemotherapy (NAC) prior to curative-intent resection. Although NAC enhances locoregional control and comprehensive patient care, survival rates remain poor, and further investigations should establish outcomes assessment of current clinical pathways. Individually assessed parameters have served as benchmarks for treatment quality in the past decades. The Outcome4Medicine Consensus Conference underscores the inadequacy of isolated metrics, leading to increased recognition and adoption of composite measures. One of the most simple and comprehensive is the “All or None” method, which refers to an approach where a specific set of criteria must be fulfilled for an individual to achieve the overall measure. This narrative review aims to present the rationale for the implementation of a novel composite measure, Textbook Neoadjuvant Outcome (TNO). TNO integrates five objective and well-established components: Treatment Toxicity, Laboratory Tests, Imaging, Time to Surgery, and Nutrition. It represents a desired, multidisciplinary care and hospitalization of GC patients undergoing NAC to identify the treatment- and patient-related data required to establish high-quality oncological care further. A key strength of this narrative review is the clinical feasibility and research background supporting the implementation of the first and novel composite measure representing the “ideal” and holistic care among patients with locally advanced esophago-gastric junction (EGJ) and GC in the preoperative period after NAC. Further analysis will correlate clinical outcomes with the prognostic factors evaluated within the TNO framework.
预计到2040年，胃癌（GC）的发病率将增至177万例。为提高治疗效果，越来越多的胃癌患者在根治性切除术前接受新辅助化疗（NAC）。尽管NAC能加强局部区域控制和综合患者管理，但生存率仍然较低，需进一步研究以评估当前临床路径的治疗效果。过去几十年中，单独评估的参数一直是治疗质量的基准。Outcome4Medicine共识会议强调了孤立指标的不足，促使综合指标的认可度和应用度日益提升。其中最简单全面的方法之一是“全或无”评估法，该方法要求个体必须满足特定标准集才能达到整体评估目标。本文旨在阐述实施新型综合指标——教科书式新辅助治疗结局（TNO）的理论依据。TNO整合了五个客观且成熟的组成部分：治疗毒性、实验室检查、影像学评估、手术时机和营养状况。该指标体现了接受NAC的胃癌患者所需的多学科协同治疗与住院管理标准，通过整合治疗相关和患者相关数据，为建立高质量肿瘤诊疗体系提供依据。本综述的核心优势在于其临床可行性和研究背景支持——TNO作为首个新型综合指标，代表了局部晚期食管胃结合部（EGJ）癌与胃癌患者在NAC术后围手术期获得“理想”整体治疗的评估标准。后续分析将把临床结局与TNO框架内评估的预后因素进行相关性研究。
肿瘤(癌症)患者之家