Update and Interpretation of 2022 National Comprehensive Cancer Network Clinical Practice Guidelines for Gastric Cancer

Recently, National Comprehensive Cancer Network(NCCN) released the latest version of clinical practice guidelines for gastric cancer. In this version, evaluation of peritoneal metastasis using laparoscopy with cytology has been refined. Postoperative chemoradiation is recommended as an alternative option for patients who have received less than a D2 lymph node dissection. The use of three cytotoxic drugs in a regimen should be reserved for medically fit patients with excellent performance status and easy access to frequent toxicity evaluation. More importantly, next generation sequencing (NGS) is recommended for the first time for the detection of microsatellite instability/mismatch repair(MSI/MMR)status. In addition, the recommendation for the detection of MSI/MMR status is extended to all newly diagnosed cases. Several recently developed targeted drugs and immuno-oncology therapy are included in the recommendation for sequential treatment. Precise treatment strategy based on biomarkers will inevitably become the future direction for gastric cancer. This article aims to interpret the updates to provide reference for clinical practice.