Gastric cancer liver metastasis (GCLM) is the most common hematogenous metastatic pattern of gastric cancer and a critical determinant of poor prognosis. Its management remains highly challenging and requires complex clinical decision-making as well as multidisciplinary team (MDT) collaboration. In recent years, a deeper understanding of gastric cancer heterogeneity—particularly the release of the Chinese Consensus Classification for Gastric Cancer Liver Metastasis (C-GCLM) and vigorous development of molecular subtyping research—has catalyzed a paradigm shift in the management of GCLM. The conventional approach, characterized by empirical decision-making and single-modality interventions, is gradually being replaced by a precision-based, MDT-driven model that emphasizes integrated, whole-course care. This review systematically summarizes the epidemiological characteristics and advances in diagnostic technologies for GCLM, with a focus on comprehensive treatment strategies based on the C-GCLM and molecular subtyping.
Citation： CHEN Lin, LI Li. Current status and advances in diagnosis and treatment of gastric cancer liver metastases: based on the Chinese Consensus Classification for Gastric Cancer Liver Metastasis and molecular subtypes. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(5): 603-609. doi: 10.7507/1007-9424.202603101 Copy
Copyright ? the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
| 1. | Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263. |
| 2. | Xu Y, Xia C, Wang J, et al. Divergent trends in the burden of esophageal, gastric, and liver cancers in China. J Natl Cancer Cent, 2025, 5(3): 306-312. |
| 3. | Luan X, Han X, Wang Z, et al. Heterogeneity of metastatic gastric cancer: solitary non-regional lymph node metastasis and solitary lung metastasis showed better survival outcomes than other metastatic patterns. BMC Cancer, 2025, 25(1): 1287. doi: 10.1186/s12885-025-14748-y. |
| 4. | Marte G, Tufo A, Steccanella F, et al. Efficacy of surgery for the treatment of gastric cancer liver metastases: a systematic review of the literature and meta-analysis of prognostic factors. J Clin Med, 2021, 10(5): 1141. doi: 10.3390/jcm10051141. |
| 5. | 中國抗癌協會胃癌專業委員會, 中國醫師協會外科醫師分會上消化道外科醫師專家工作組, 中國老年保健協會消化系統疾病診療分會, 等. 胃癌肝轉移診斷與綜合治療中國專家共識(2026版). 中國實用外科雜志, 2026, 46(2): 153-161. |
| 6. | Jia Y, Wang Y, Li H, et al. Clinical value of CA125, AFP, and CEA for combined diagnosis and assessment of gastric cancer prognosis. Front Oncol, 2025, 15: 1530522. doi: 10.3389/fonc.2025.1530522. |
| 7. | Wildman-Tobriner B, Felice N, Kalisz KR, et al. Photon-counting CT effects on sensitivity for liver lesion detection: a reader study using virtual imaging. Radiology, 2025, 314(1): e241568. doi: 10.1148/radiol.241568. |
| 8. | Giandola T, Maino C, Marrapodi G, et al. Imaging in gastric cancer: current practice and future perspectives. Diagnostics (Basel), 2023, 13(7): 1276. doi: 10.3390/diagnostics13071276. |
| 9. | Tatsubayashi T, Tanizawa Y, Miki Y, et al. Treatment outcomes of hepatectomy for liver metastases of gastric cancer diagnosed using contrast-enhanced magnetic resonance imaging. Gastric Cancer, 2017, 20(2): 387-393. |
| 10. | Borggreve AS, Goense L, Brenkman H, et al. Imaging strategies in the management of gastric cancer: current role and future potential of MRI. Br J Radiol, 2019, 92(1097): 20181044. doi: 10.1259/bjr.20181044. |
| 11. | Findlay JM, Antonowicz S, Segaran A, et al. Routinely staging gastric cancer with 18F-FDG PET-CT detects additional metastases and predicts early recurrence and death after surgery. Eur Radiol, 2019, 29(5): 2490-2498. |
| 12. | Liu X, Liu H, Gao C, et al. Comparison of 68Ga-FAPI and 18F-FDG PET/CT for the diagnosis of primary and metastatic lesions in abdominal and pelvic malignancies: a systematic review and meta-analysis. Front Oncol, 2023, 13: 1093861. doi: 10.3389/fonc.2023.1093861. |
| 13. | Chen H, Pang Y, Wu J, et al. Comparison of [68Ga]Ga-DOTA-FAPI-04 and [18F] FDG PET/CT for the diagnosis of primary and metastatic lesions in patients with various types of cancer. Eur J Nucl Med Mol Imaging, 2020, 47(8): 1820-1832. |
| 14. | Lv J, Zheng K, Jiang C, et al. Evaluating the diagnostic performance of [18F] ALF-NOTA-FAPI-04 PET/CT in gastric cancer: a comparative study with [18F] FDG PET/CT. Eur Radiol, 2025, 35(6): 3314-3323. |
| 15. | Lin R, Lin Z, Chen Z, et al. [68Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of gastric cancer: comparison with [18F]FDG PET/CT. Eur J Nucl Med Mol Imaging, 2022, 49(8): 2960-2971. |
| 16. | Qin C, Shao F, Gai Y, et al. 68Ga-DOTA-FAPI-04 PET/MR in the evaluation of gastric carcinomas: comparison with 18F-FDG PET/CT. J Nucl Med, 2022, 63(1): 81-88. |
| 17. | Dabir M, Novruzov E, Mattes-Gy?rgy K, et al. Distinguishing benign and malignant findings on [68Ga]-FAPI PET/CT based on quantitative SUV measurements. Mol Imaging Biol, 2023, 25(2): 324-333. |
| 18. | Giesel FL, Kratochwil C, Lindner T, et al. 68Ga-FAPI PET/CT: biodistribution and preliminary dosimetry estimate of 2 DOTA-containing FAP-targeting agents in patients with various cancers. J Nucl Med, 2019, 60(3): 386-392. |
| 19. | She Y, Liu X, Liu H, et al. Combination of clinical and spectral-CT iodine concentration for predicting liver metastasis in gastric cancer: a preliminary study. Abdom Radiol (NY), 2024, 49(10): 3438-3449. |
| 20. | Hou C, Wang F, Prince M, et al. CT-based liver peritumoural radiomics features predict hepatic metastases sources as gastrointestinal or non-gastrointestinal. Br J Radiol, 2025, 98(1167): 458-468. |
| 21. | 薛鵬宇, 王利皓, 薛飛. 術中超聲造影在肝臟惡性腫瘤切除中的應用. 中華肝膽外科雜志, 2025, 31(12): 948-952. |
| 22. | Khalifa A, Sasso R, Rockey DC. Role of liver biopsy in assessment of radiologically identified liver masses. Dig Dis Sci, 2022, 67(1): 337-343. |
| 23. | Song Z, Zou S, Zhou W, et al. Clinically applicable histopathological diagnosis system for gastric cancer detection using deep learning. Nat Commun, 2020, 11(1): 4294. doi: 10.1038/s41467-020-18147-8. |
| 24. | Yoshida K, Yamaguchi K, Okumura N, et al. Is conversion therapy possible in stage Ⅳ gastric cancer: the proposal of new biological categories of classification. Gastric Cancer, 2016, 19(2): 329-338. |
| 25. | Yasufuku I, Kinoshita T, Bando E, et al. Safety, survival outcomes, and prognostic factors in conversion surgery for advanced gastric cancer: a sub-analysis of Japanese patients in the CONVO-GC-1 study. Gastric Cancer, 2026, 29(1): 177-190. |
| 26. | Takahashi K, Terashima M, Notsu A, et al. Surgical treatment for liver metastasis from gastric cancer: a systematic review and meta-analysis of long-term outcomes and prognostic factors. Eur J Surg Oncol, 2024, 50(10): 108582. doi: 10.1016/j.ejso.2024.108582. |
| 27. | Wang C, Zhang Y, Zhang Y, et al. A bibliometric analysis of gastric cancer liver metastases: advances in mechanisms of occurrence and treatment options. Int J Surg, 2024, 110(4): 2288-2299. |
| 28. | Japanese Research Society for Gastric Cancer. Japanese Classification of Gastric Carcinoma. Tokyo: Kanehara & Co. , Ltd, 1995. |
| 29. | Hori S, Honda M, Kobayashi H, et al. A grading system for predicting the prognosis of gastric cancer with liver metastasis. Jpn J Clin Oncol, 2021, 51(11): 1601-1607. |
| 30. | Xiao Y, Zhang B, Wu Y. Prognostic analysis and liver metastases relevant factors after gastric and hepatic surgical treatment in gastric cancer patients with metachronous liver metastases: a population-based study. Ir J Med Sci, 2019, 188(2): 415-424. |
| 31. | Gao Y, Xi H, Shang L, et al. Clinical landscape and prognosis of patients with gastric cancer liver metastases: a nation-wide multicenter cohort study in China (RECORD study). Sci Bull (Beijing), 2024, 69(3): 303-307. |
| 32. | Ajani JA, D’Amico TA, Bentrem DJ, et al. Gastric cancer, version 2. 2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2022, 20(2): 167-192. |
| 33. | 中國抗癌協會胃癌專業委員會, 中國醫師協會外科醫師分會上消化道外科醫師專家工作組, 中國老年保健協會消化系統疾病診療分會, 等. 胃癌肝轉移診斷與綜合治療中國專家共識(2024版). 中國實用外科雜志, 2024, 44(5): 481-489. |
| 34. | 陳凜, 郗洪慶, 申偉松. 積極開展對胃癌肝轉移的多學科團隊綜合治療. 中華胃腸外科雜志, 2014, 17(2): 101-104. |
| 35. | Zhang K, Chen L. Chinese consensus on the diagnosis and treatment of gastric cancer with liver metastases. Ther Adv Med Oncol, 2020, 12: 1758835920904803. doi: 10.1177/1758835920904803. |
| 36. | Williams GJ, Thompson JF. Management changes and survival outcomes for cancer patients after multidisciplinary team discussion; a systematic review and meta-analysis. Cancer Treat Rev, 2025, 139: 102997. doi: 10.1016/j.ctrv.2025.102997. |
| 37. | Ju M, Wang SC, Syed S, et al. Multidisciplinary teams improve gastric cancer treatment efficiency at a Large Safety Net Hospital. Ann Surg Oncol, 2020, 27(3): 645-650. |
| 38. | Brodkin J, Kaprio T, Hagstr?m J, et al. Prognostic effect of immunohistochemically determined molecular subtypes in gastric cancer. BMC Cancer, 2024, 24(1): 1482. doi: 10.1186/s12885-024-13236-z. |
| 39. | K?rfer J, Lordick F, Hacker UT. Molecular targets for gastric cancer treatment and future perspectives from a clinical and translational point of view. Cancers (Basel), 2021, 13(20): 5216. doi: 10.3390/cancers13205216. |
| 40. | Li F, Deng H, Hu Z, et al. Immunohistochemical-based molecular typing of ACRG combined with immune-associated PD-L1 expression can predict the prognosis of gastric cancer. Cancer Med, 2025, 14(7): e70863. doi: 10.1002/cam4.70863. |
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| 43. | Shitara K, Lordick F, Bang Y et al. Zolbetuximab plus mFOLFOX6 in patients with CLDN18.2-positive, HER2-negative, untreated, locally advanced unresectable or metastatic gastric or gastro-oesophageal junction adenocarcinoma (SPOTLIGHT): a multicentre, randomised, double-blind, phase 3 trial. Lancet, 2023, 401: 1655-1668. |
| 44. | Shah MA, Shitara K, Ajani JA, et al. Zolbetuximab plus CAPOX in CLDN18.2-positive gastric or gastroesophageal junction adenocarcinoma: the randomized, phase 3 GLOW trial. Nat Med, 2023, 29(8): 2133-2141. |
| 45. | Wainberg ZA, Kang YK, Lee KW, et al. Bemarituzumab as first-line treatment for locally advanced or metastatic gastric/gastroesophageal junction adenocarcinoma: final analysis of the randomized phase 2 FIGHT trial. Gastric Cancer, 2024, 27(3): 558-570. |
| 46. | Qiu MZ, Oh DY, Kato K, et al. Tislelizumab plus chemotherapy versus placebo plus chemotherapy as first line treatment for advanced gastric or gastro-oesophageal junction adenocarcinoma: RATIONALE-305 randomised, double blind, phase 3 trial. BMJ, 2024, 385: e078876. doi: 10.1136/bmj-2023-078876. |
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| 48. | Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet, 2021, 398(10294): 27-40. |
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| 51. | Petrelli F, Coinu A, Cabiddu M, et al. Hepatic resection for gastric cancer liver metastases: a systematic review and meta-analysis. J Surg Oncol, 2015, 111(8): 1021-1027. |
| 52. | Tang K, Zhang B, Dong L, et al. Radiofrequency ablation versus traditional liver resection and chemotherapy for liver metastases from gastric cancer. J Int Med Res, 2020, 48(7): 300060520940509. doi: 10.1177/0300060520940509. |
| 53. | Ryu T, Takami Y, Wada Y, et al. Oncological outcomes after hepatic resection and/or surgical microwave ablation for liver metastasis from gastric cancer. Asian J Surg, 2019, 42(1): 100-105. |
| 54. | Qiang W, Shi H, Wu J, et al. Hepatic arterial infusion combined with systemic chemotherapy for patients with extensive liver metastases from gastric cancer. Cancer Manag Res, 2020, 12: 2911-2916. |
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- 1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
- 2. Xu Y, Xia C, Wang J, et al. Divergent trends in the burden of esophageal, gastric, and liver cancers in China. J Natl Cancer Cent, 2025, 5(3): 306-312.
- 3. Luan X, Han X, Wang Z, et al. Heterogeneity of metastatic gastric cancer: solitary non-regional lymph node metastasis and solitary lung metastasis showed better survival outcomes than other metastatic patterns. BMC Cancer, 2025, 25(1): 1287. doi: 10.1186/s12885-025-14748-y.
- 4. Marte G, Tufo A, Steccanella F, et al. Efficacy of surgery for the treatment of gastric cancer liver metastases: a systematic review of the literature and meta-analysis of prognostic factors. J Clin Med, 2021, 10(5): 1141. doi: 10.3390/jcm10051141.
- 5. 中國抗癌協會胃癌專業委員會, 中國醫師協會外科醫師分會上消化道外科醫師專家工作組, 中國老年保健協會消化系統疾病診療分會, 等. 胃癌肝轉移診斷與綜合治療中國專家共識(2026版). 中國實用外科雜志, 2026, 46(2): 153-161.
- 6. Jia Y, Wang Y, Li H, et al. Clinical value of CA125, AFP, and CEA for combined diagnosis and assessment of gastric cancer prognosis. Front Oncol, 2025, 15: 1530522. doi: 10.3389/fonc.2025.1530522.
- 7. Wildman-Tobriner B, Felice N, Kalisz KR, et al. Photon-counting CT effects on sensitivity for liver lesion detection: a reader study using virtual imaging. Radiology, 2025, 314(1): e241568. doi: 10.1148/radiol.241568.
- 8. Giandola T, Maino C, Marrapodi G, et al. Imaging in gastric cancer: current practice and future perspectives. Diagnostics (Basel), 2023, 13(7): 1276. doi: 10.3390/diagnostics13071276.
- 9. Tatsubayashi T, Tanizawa Y, Miki Y, et al. Treatment outcomes of hepatectomy for liver metastases of gastric cancer diagnosed using contrast-enhanced magnetic resonance imaging. Gastric Cancer, 2017, 20(2): 387-393.
- 10. Borggreve AS, Goense L, Brenkman H, et al. Imaging strategies in the management of gastric cancer: current role and future potential of MRI. Br J Radiol, 2019, 92(1097): 20181044. doi: 10.1259/bjr.20181044.
- 11. Findlay JM, Antonowicz S, Segaran A, et al. Routinely staging gastric cancer with 18F-FDG PET-CT detects additional metastases and predicts early recurrence and death after surgery. Eur Radiol, 2019, 29(5): 2490-2498.
- 12. Liu X, Liu H, Gao C, et al. Comparison of 68Ga-FAPI and 18F-FDG PET/CT for the diagnosis of primary and metastatic lesions in abdominal and pelvic malignancies: a systematic review and meta-analysis. Front Oncol, 2023, 13: 1093861. doi: 10.3389/fonc.2023.1093861.
- 13. Chen H, Pang Y, Wu J, et al. Comparison of [68Ga]Ga-DOTA-FAPI-04 and [18F] FDG PET/CT for the diagnosis of primary and metastatic lesions in patients with various types of cancer. Eur J Nucl Med Mol Imaging, 2020, 47(8): 1820-1832.
- 14. Lv J, Zheng K, Jiang C, et al. Evaluating the diagnostic performance of [18F] ALF-NOTA-FAPI-04 PET/CT in gastric cancer: a comparative study with [18F] FDG PET/CT. Eur Radiol, 2025, 35(6): 3314-3323.
- 15. Lin R, Lin Z, Chen Z, et al. [68Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of gastric cancer: comparison with [18F]FDG PET/CT. Eur J Nucl Med Mol Imaging, 2022, 49(8): 2960-2971.
- 16. Qin C, Shao F, Gai Y, et al. 68Ga-DOTA-FAPI-04 PET/MR in the evaluation of gastric carcinomas: comparison with 18F-FDG PET/CT. J Nucl Med, 2022, 63(1): 81-88.
- 17. Dabir M, Novruzov E, Mattes-Gy?rgy K, et al. Distinguishing benign and malignant findings on [68Ga]-FAPI PET/CT based on quantitative SUV measurements. Mol Imaging Biol, 2023, 25(2): 324-333.
- 18. Giesel FL, Kratochwil C, Lindner T, et al. 68Ga-FAPI PET/CT: biodistribution and preliminary dosimetry estimate of 2 DOTA-containing FAP-targeting agents in patients with various cancers. J Nucl Med, 2019, 60(3): 386-392.
- 19. She Y, Liu X, Liu H, et al. Combination of clinical and spectral-CT iodine concentration for predicting liver metastasis in gastric cancer: a preliminary study. Abdom Radiol (NY), 2024, 49(10): 3438-3449.
- 20. Hou C, Wang F, Prince M, et al. CT-based liver peritumoural radiomics features predict hepatic metastases sources as gastrointestinal or non-gastrointestinal. Br J Radiol, 2025, 98(1167): 458-468.
- 21. 薛鵬宇, 王利皓, 薛飛. 術中超聲造影在肝臟惡性腫瘤切除中的應用. 中華肝膽外科雜志, 2025, 31(12): 948-952.
- 22. Khalifa A, Sasso R, Rockey DC. Role of liver biopsy in assessment of radiologically identified liver masses. Dig Dis Sci, 2022, 67(1): 337-343.
- 23. Song Z, Zou S, Zhou W, et al. Clinically applicable histopathological diagnosis system for gastric cancer detection using deep learning. Nat Commun, 2020, 11(1): 4294. doi: 10.1038/s41467-020-18147-8.
- 24. Yoshida K, Yamaguchi K, Okumura N, et al. Is conversion therapy possible in stage Ⅳ gastric cancer: the proposal of new biological categories of classification. Gastric Cancer, 2016, 19(2): 329-338.
- 25. Yasufuku I, Kinoshita T, Bando E, et al. Safety, survival outcomes, and prognostic factors in conversion surgery for advanced gastric cancer: a sub-analysis of Japanese patients in the CONVO-GC-1 study. Gastric Cancer, 2026, 29(1): 177-190.
- 26. Takahashi K, Terashima M, Notsu A, et al. Surgical treatment for liver metastasis from gastric cancer: a systematic review and meta-analysis of long-term outcomes and prognostic factors. Eur J Surg Oncol, 2024, 50(10): 108582. doi: 10.1016/j.ejso.2024.108582.
- 27. Wang C, Zhang Y, Zhang Y, et al. A bibliometric analysis of gastric cancer liver metastases: advances in mechanisms of occurrence and treatment options. Int J Surg, 2024, 110(4): 2288-2299.
- 28. Japanese Research Society for Gastric Cancer. Japanese Classification of Gastric Carcinoma. Tokyo: Kanehara & Co. , Ltd, 1995.
- 29. Hori S, Honda M, Kobayashi H, et al. A grading system for predicting the prognosis of gastric cancer with liver metastasis. Jpn J Clin Oncol, 2021, 51(11): 1601-1607.
- 30. Xiao Y, Zhang B, Wu Y. Prognostic analysis and liver metastases relevant factors after gastric and hepatic surgical treatment in gastric cancer patients with metachronous liver metastases: a population-based study. Ir J Med Sci, 2019, 188(2): 415-424.
- 31. Gao Y, Xi H, Shang L, et al. Clinical landscape and prognosis of patients with gastric cancer liver metastases: a nation-wide multicenter cohort study in China (RECORD study). Sci Bull (Beijing), 2024, 69(3): 303-307.
- 32. Ajani JA, D’Amico TA, Bentrem DJ, et al. Gastric cancer, version 2. 2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2022, 20(2): 167-192.
- 33. 中國抗癌協會胃癌專業委員會, 中國醫師協會外科醫師分會上消化道外科醫師專家工作組, 中國老年保健協會消化系統疾病診療分會, 等. 胃癌肝轉移診斷與綜合治療中國專家共識(2024版). 中國實用外科雜志, 2024, 44(5): 481-489.
- 34. 陳凜, 郗洪慶, 申偉松. 積極開展對胃癌肝轉移的多學科團隊綜合治療. 中華胃腸外科雜志, 2014, 17(2): 101-104.
- 35. Zhang K, Chen L. Chinese consensus on the diagnosis and treatment of gastric cancer with liver metastases. Ther Adv Med Oncol, 2020, 12: 1758835920904803. doi: 10.1177/1758835920904803.
- 36. Williams GJ, Thompson JF. Management changes and survival outcomes for cancer patients after multidisciplinary team discussion; a systematic review and meta-analysis. Cancer Treat Rev, 2025, 139: 102997. doi: 10.1016/j.ctrv.2025.102997.
- 37. Ju M, Wang SC, Syed S, et al. Multidisciplinary teams improve gastric cancer treatment efficiency at a Large Safety Net Hospital. Ann Surg Oncol, 2020, 27(3): 645-650.
- 38. Brodkin J, Kaprio T, Hagstr?m J, et al. Prognostic effect of immunohistochemically determined molecular subtypes in gastric cancer. BMC Cancer, 2024, 24(1): 1482. doi: 10.1186/s12885-024-13236-z.
- 39. K?rfer J, Lordick F, Hacker UT. Molecular targets for gastric cancer treatment and future perspectives from a clinical and translational point of view. Cancers (Basel), 2021, 13(20): 5216. doi: 10.3390/cancers13205216.
- 40. Li F, Deng H, Hu Z, et al. Immunohistochemical-based molecular typing of ACRG combined with immune-associated PD-L1 expression can predict the prognosis of gastric cancer. Cancer Med, 2025, 14(7): e70863. doi: 10.1002/cam4.70863.
- 41. Shitara K, Van Cutsem E, Gümü? M, et al. Trastuzumab deruxtecan or ramucirumab plus paclitaxel in gastric cancer. N Engl J Med, 2025, 24, 393(4): 336-348.
- 42. Lee KW, Bai LY, Jung M, et al. Phase Ⅰb/Ⅱ study of zanidatamab in combination with tislelizumab and chemotherapy in first-line HER2-positive gastric/gastroesophageal junction adenocarcinoma. Clin Cancer Res, 2026, 32(2): 312-323.
- 43. Shitara K, Lordick F, Bang Y et al. Zolbetuximab plus mFOLFOX6 in patients with CLDN18.2-positive, HER2-negative, untreated, locally advanced unresectable or metastatic gastric or gastro-oesophageal junction adenocarcinoma (SPOTLIGHT): a multicentre, randomised, double-blind, phase 3 trial. Lancet, 2023, 401: 1655-1668.
- 44. Shah MA, Shitara K, Ajani JA, et al. Zolbetuximab plus CAPOX in CLDN18.2-positive gastric or gastroesophageal junction adenocarcinoma: the randomized, phase 3 GLOW trial. Nat Med, 2023, 29(8): 2133-2141.
- 45. Wainberg ZA, Kang YK, Lee KW, et al. Bemarituzumab as first-line treatment for locally advanced or metastatic gastric/gastroesophageal junction adenocarcinoma: final analysis of the randomized phase 2 FIGHT trial. Gastric Cancer, 2024, 27(3): 558-570.
- 46. Qiu MZ, Oh DY, Kato K, et al. Tislelizumab plus chemotherapy versus placebo plus chemotherapy as first line treatment for advanced gastric or gastro-oesophageal junction adenocarcinoma: RATIONALE-305 randomised, double blind, phase 3 trial. BMJ, 2024, 385: e078876. doi: 10.1136/bmj-2023-078876.
- 47. Zhang X, Wang J, Wang G, et al. First-line sugemalimab plus chemotherapy for advanced gastric cancer: the GEMSTONE-303 randomized clinical trial. JAMA, 2025, 333(15): 1305-1314.
- 48. Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet, 2021, 398(10294): 27-40.
- 49. Rha SY, Oh DY, Ya?ez P, et al. Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for HER2-negative advanced gastric cancer (KEYNOTE-859): a multicentre, randomised, double-blind, phase 3 trial. Lancet Oncol, 2023, 24(11): 1181-1195.
- 50. Kawakami H, Kadowaki S, Makiyama A, et al. Phase Ⅱ study (NO LIMIT, WJOG13320G) of first-line nivolumab plus low-dose ipilimumab for microsatellite instability-high advanced gastric or esophagogastric junction cancer. J Clin Oncol, 2025, 43(19): 2184-2195.
- 51. Petrelli F, Coinu A, Cabiddu M, et al. Hepatic resection for gastric cancer liver metastases: a systematic review and meta-analysis. J Surg Oncol, 2015, 111(8): 1021-1027.
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