Which gastric cancer patients need adjuvant radiotherapy and chemotherapy after surgery

For patients with gastric cancer in stage 0 and stage I, radical surgery is the main treatment method. After surgery, only regular follow-up is required, and adjuvant therapy is generally not required. For patients with gastric cancer in stage II to III, adjuvant chemotherapy and radiotherapy are required after radical surgery. The main indicators of adjuvant chemotherapy and radiotherapy for gastric cancer patients after surgery are as follows.

1. Patients with gastric cancer at T1 and N0 generally do not receive chemotherapy after surgery, but they need medical observation and regular follow-up examinations. For patients with early gastric cancer and Helicobacter pylori (Hp) infection, the domestic recommendation is that patients who undergo local resection or subtotal gastrectomy should receive treatment to eliminate Hp infection after surgery.

2. Patients with gastric cancer at T2 and N0 can be followed up and observed if there are no high-risk factors after surgery. However, if there are high-risk factors, such as low tumor differentiation or high histological grade, lymphovascular invasion, neural invasion, and age less than 50 years old, it is recommended to receive adjuvant chemotherapy or radiotherapy after surgery.

3. For patients with T3, T4 or any gastric cancer with lymph node metastasis who have achieved R0 resection, they should receive chemotherapy and radiotherapy after surgery.

4. Patients with R1 resection and R2 resection without metastasis should receive radiotherapy + chemotherapy after surgery. (R1 resection means that there is tumor residue under the microscope, and R2 resection means that there is tumor residue under the naked eye).