Oncology Frontier: From your perspective， what are the most important aspects for improving outcomes in the treatment of upper GI cancers?

　　《肿瘤瞭望》：改善上消化道癌症治疗预后的关键所在？

　　Dr Catenacci: The important aspects in improving outcomes for these cancers will include better and more accurate diagnostic staging. The question of whether diagnostic laparoscopy is needed in addition to CT scans， PET scans， endoscopic ultrasound， etc.， came up in our session also. In our institution， doing a diagnostic laparoscopy is our approach with certain stages (stage II or greater with lymph node involvement) and for sure in the gastric setting. You can make an argument for the GE junction setting also. There is an occult metastatic rate in the gastric cancer setting of upwards of 30% that are not detected on PET scan or CT scan. We call them potentially curatively resectable but they are actually metastatic if you do a diagnostic laparoscopy. Similarly in the GE junction/esophageal cancers， there is a lower rate but there is still a rate of occult peritoneal disease approaching even 10% especially if there are signet rings or high-grade features. So number one is to better stage them， then better molecular classification potentially with novel agents may help us with outcomes going forward. This is ongoing in our trial designs and our main focus.

　　Catenacci博士：要改善癌症治疗效果，提高诊断分期的准确性更加重要。诊断患者除了需要CT扫描、PET扫描、超声内镜等，有些患者还需要腹腔镜诊断。我所在的机构只对一部分胃癌/胃食管连接部癌做腹腔镜诊断（Ⅱ期以上淋巴结受累患者）。超过30%胃癌隐匿转移PET扫描或CT扫描检测不到，但是用腹腔镜可检查到，可行根治性手术。胃食管连接部癌/食管癌也会出现10%的隐匿腹膜转移，印戒细胞癌或高级别癌症更会如此。所以，要提高上消化道癌症的预后，首先是分期准确，然后是分子分型准确。目前试验设计已经这样做了，这也是我的研究重点之一。

　　Oncology Frontier: Could you share your opinion on the multidisciplinary management of upper GI cancer treatment?

　　《肿瘤瞭望》：请您谈一谈上消化道癌症多学科综合管理。

　　Dr Catenacci: Initially with staging there are radiologists， gastroenterologists， medical oncologists and surgeons and laparoscopic surgeons involved. With treatment with a multidisciplinary approach， at least chemotherapy and a surgery are involved with or without radiation. We encourage all of these cases to be discussed at multidisciplinary conferences with representatives from each of these disciplines so that a consensus can be formed to best treat that patient taking all factors into account including comorbidities just like the cases we have been discussing at this conference. There is a lack of consensus even in patients who could get either treatment， but when you throw in comorbidities then maybe one of them may be better suited for that particular individual patient.

　　Catenacci博士：多学科综合管理第一步是肿瘤分期，需要放射科、消化科、肿瘤内科和外科医生以及腹腔镜外科介入。肿瘤多学科治疗涉及化疗、手术和/或放疗等综合治疗。在多学科会议上多个领域的专家一起讨论同一个病例，把各个因素（包括并发症）考虑在内以提出最佳治疗方案，这种形式的讨论值得提倡。患者应该怎样治疗医生们没有共识，但是如果把并发症考虑在内，可能某位医生能为患者提供合适的治疗方案。