Zenkuan Xu, surgeon, First Affiliated Hospital of Nanjing Medical University, China

Biography

Family Name：XU First Name: Zekuan
Title: Professor/Chief Surgeon/Supervisor of Ph.D. and M.D.
Nationality: China
Current Position: Head, Gastric Cancer Center;
The First Affiliated Hospital of Nanjing Medical University
Director, Institution of Gastric Cancer, Nanjing Medical University
Council Member, International Gastric Cancer Association (IGCA)
Fellow, American College of Surgeons (FACS)
Member of Surgery Branch, Chinese Medical Association
Council Member, Surgeon Branch, Chinese Medical Doctor Association
Chair of Surgical Branch, Jiangsu Medical Doctor Association

Summary of presentation

Although China has made significant progress in gastric cancer clinical research in recent years, there are still many unanswered questions. These regions are global leaders in early screening technologies, precision medicine, and molecular targeted therapies, while China’s research focus remains largely on optimizing surgical techniques, neoadjuvant treatments, and perioperative management.

For early gastric cancer (EGC), endoscopic treatments, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), have proven effective for patients with a very low risk of lymph node metastasis.

In neoadjuvant therapy, China has made key breakthroughs. The bispecific antibody AK104, targeting both PD-1 and CTLA-4, has shown promising efficacy and is being investigated for its role in neoadjuvant immunotherapy. Claudin18.2-targeting monoclonal antibodies have also demonstrated substantial therapeutic potential in clinical trials, particularly for patients with high Claudin18.2 expression.

In surgical treatment, China has made major advancements through the CLASS (Chinese Laparoscopic Gastrointestinal Surgery Study) series. CLASS-01 demonstrated the non-inferiority of laparoscopic distal gastrectomy compared to open surgery for locally advanced gastric cancer, laying the foundation for the widespread adoption of laparoscopic techniques in China. CLASS-02 further validated that laparoscopic total gastrectomy is comparable to open surgery in terms of safety and efficacy. Moreover, the introduction and widespread use of the Da Vinci robotic surgical system have enhanced precision, minimized surgical trauma, and improved safety, as demonstrated by CLASS-03 and other studies on robot-assisted gastrectomy. These minimally invasive approaches not only improve postoperative recovery but also enhance patients’ quality of life. Meanwhile, clinical trials on hyperthermic intraperitoneal chemotherapy (HIPEC) are exploring its potential for preventing and treating peritoneal metastasis in gastric cancer, with promising results in improving disease-free survival.

For advanced gastric cancer, first-line immunotherapy combined with chemotherapy has significantly expanded treatment options. Studies such as GEMSTONE-303, RATIONALE-305, and KEYNOTE-859 have demonstrated that PD-1 and PD-L1 inhibitors, including sugemalimab, tislelizumab, and pembrolizumab, improve progression-free survival (PFS), overall survival (OS), and response rates, particularly in patients with high PD-L1 expression. These findings establish multiple effective immunotherapy-based regimens for advanced gastric cancer.

Despite these achievements, significant challenges remain. The lack of high-quality multi-center randomized controlled trials (RCTs) limits the reliability and generalizability of findings. Furthermore, China’s innovation in immunotherapy and targeted therapy still relies heavily on international research rather than domestic breakthroughs.Overall, while China has achieved significant advancements in surgical techniques, neoadjuvant therapies, and AI technologies, there remains a need to improve the scale and quality of RCTs, drive domestic drug innovation, advance translational molecular diagnostics, and increase early screening coverage. Moving forward, China should prioritize international collaboration, increase investment in basic research and clinical trials, and accelerate the development of localized innovative therapies to enhance gastric cancer diagnosis, treatment, and patient survival outcomes comprehensively.