Shen Li ,Fei Shan ,Xiaotian Zhang ,Yongheng Li ,Yu Sun ,Lei Tang ,Qi Wu,Wenjing Yang,Jincheng Yang,Yu An,Ming Deng,Jiafu Ji

Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Gastrointestinal Cancer Center;2Department of Gastrointestinal Oncology;3 Department of Radiotherapy;4 Department of Pathology;5 Department of Radiology;6 Endoscopy Center;Peking University Cancer Hospital ＆amp;Institute,Beijing 100142,China;7Office for Cancer Diagnosis and Treatment Quality Control,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China

Abstract Gastric cancer is one of the most common malignancies of the digestive system,and the number of deaths continues to increase.The standardized management of the diagnosis and treatment of gastric cancer is challenging due to the great differences in the diagnosis and treatment of gastric cancer in different regions.The Gastric Cancer Expert Committee of the National Cancer Quality Control Center (NCQCC) identified a lack of authoritative quality control standards as an opportunity to utilize its multidisciplinary membership to improve the standardized diagnosis and treatment of gastric cancer.The Gastric Cancer Expert Committee of the NCQCC aims to promote quality control and national standardization,uniformity,and normalization of gastric cancer diagnosis and treatment,which ultimately improved the survival rate and quality of life of gastric cancer patients.A panel of experts with gastrointestinal cancer surgery,gastrointestinal cancer medicine,medical imaging,pathology and radiotherapy were drawn together and determined the quality control standards for the standardized diagnosis and treatment of gastric cancer.The authors then utilized a modified Delphi approach to generate consensus recommendations.

Keywords: Gastric cancer;standardized diagnosis and treatment;quality control index

Introduction

Gastric cancer is one of the most common malignancies of the digestive tract.In the world,gastric cancer has the fifth highest incidence among cancers and fourth highest cancer-related death;therefore,it represents a major burden to patients and their families.Although the development of research on the pathogen,screening,and clinical treatment of gastric cancer has gained major improvements in the survival of patients with gastric cancer;there are still major differences in the level of diagnosis and treatment among different regions in China.

In 2012,the National Health Commission established the National Cancer Quality Control Center (NCQCC) to promote quality control and national standardization,uniformity,and normalization of cancer diagnosis and treatment,which ultimately improved the survival and quality of life of cancer patients.

To further promote standardized diagnosis and quality control of gastric cancer treatment,the National Cancer Center and the NCQCC commissioned the Gastric Cancer Expert Committee to draft and formulate the Chinese quality control indices for standardized diagnosis and treatment of gastric cancer (2022 edition) based on the“Gastric Cancer Diagnosis and Treatment Guidelines(2022 edition),” the “Chinese Society of Clinical Oncology(CSCO) Gastric Cancer Treatment Guidelines (2021)”,and other authoritative domestic and international guidelines,as well as evidence-based medicine and clinical experience following scientific,universal,normative and operational principles.

Quality control indices for gastric cancer

Rate of completion of clinical TNM staging evaluation of gastric cancer patients before the first treatment

Rate of completion of clinical TNM staging diagnosis of gastric cancer patients before the first treatment

1.Index code: GC-01-01.

2.Index name: Rate of completion of clinical TNM staging diagnosis of gastric cancer patients before the first treatment.

3.Definition: Proportion of cases of gastric cancer patients who underwent TNM staging diagnosis before the first treatment to cases of gastric cancer patients for the first treatment.

4.Method of calculation: SeeFormula 1.

5.Patient population: Hospitalized and outpatient patients.

6.Rationale: Reflects comprehensive disease evaluation before treatment and forms the basis of standardized cancer treatment.

7.Index type: Quality control of results.

8.Form of expression: Increased proportion.

9.Excluded cases: Patients with recurrence/metastasis after treatment.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition),”Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) gastric cancer TNM staging criteria (8th edition).

Rate of completion of clinical TNM staging examination and evaluation of gastric cancer patients before the first treatment

1.Index code: GC-01-02.

2.Index name: Rate of completion of clinical TNM staging examination and evaluation of gastric cancer patients before the first treatment.

3.Definition: Proportion of cases of gastric cancer patients who underwent TNM staging examination and evaluation before the first treatment to cases of gastric cancer patients for the first treatment.

4.Method of calculation: SeeFormula 2.

5.Patient population: Hospitalized patients and outpatients.

6.Rationale: Reflects comprehensive disease evaluation before treatment,forms the basis of standardized cancer treatment.

7.Index type: Quality control of results.

8.Form of expression: Increased proportion.

9.Excluded cases: Patients with recurrence/metastasis after treatment.

10.Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition),” UICC/AJCC gastric cancer TNM staging criteria (8th edition).

Rate of pathological diagnosis of gastric cancer patients before the first treatment

1.Index code: GC-02.

2.Index name: Rate of pathological diagnosis of gastric cancer patients before the first treatment.

3.Definition: Proportion of cases of gastric cancer patients who received a pathological diagnosis before the first treatment to cases of gastric cancer patients for the first treatment.

4.Method of calculation: SeeFormula 3.

5.Patient population: Hospitalized patients and outpatients.

6.Rationale: Reflects the degree of standardization of gastric cancer diagnosis and guides the selection of the first treatment strategy.

7.Index type: Quality control of results.

8.Form of expression: Increased proportion.

9.Excluded cases: Patients with recurrence/metastasis after treatment.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition)”.

Proportion of complete postoperative pathology reports of gastric cancer patients

1.Index code: GC-03.

2.Index name: Proportion of complete postoperative pathology reports of gastric cancer patients.

3. Definition: Proportion of cases of complete postoperative pathology reports of gastric cancer patients to all cases of postoperative pathology reports of gastric cancer patients.

4.Method of calculation: SeeFormula 4.

5. Patient population: Hospitalized patients and outpatients.

6.Rationale: Reflects the standardization of pathological diagnosis reports and guides postoperative adjuvant therapy for gastric cancer.

7.Index type: Quality control of results.

8.Form of expression: Increased proportion.

9.Excluded cases: None.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition)”.

Proportion of postoperative pTNM staging of gastric cancer patients

1.Index code: GC-04.

2.Index name: Proportion of postoperative pTNM staging of gastric cancer patients.

3.Definition: Proportion of cases of gastric cancer with confirmed postoperative pT (tumor staging),pN (lymph node staging) and pM (distant metastasis) to cases of gastric cancer treated by surgery.

4.Method of calculation: SeeFormula 5.

5. Patient population: Hospitalized patients and outpatients.

6.Rationale: Accurate pathological staging is an important basis for guiding subsequent treatment and determination of prognosis.

7.Index type: Quality control of results.

8.Form of expression: Increased proportion.

9.Excluded cases: Patients who underwent endoscopic surgical treatment.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition),”UICC staging criteria for gastric cancer (8th edition).

Proportion of gastric cancer patients treated using endoscopy with postoperative positive margins

1.Index code: GC-05.

2.Index name: Proportion of gastric cancer patients treated using endoscopy who had postoperative positive margins.

3.Definition: Proportion of cases of gastric cancer patients treated using endoscopy in whom postoperative pathology was suggestive of positive margins to all cases of gastric cancer patients treated using endoscopy.

4.Method of calculation: SeeFormula 6.

5. Patient population: Hospitalized patients and outpatients.

6.Rationale: Margins are a key indicator for evaluating the radicality of endoscopic treatment.Margins are also an important basis for measuring the degree of standardization of endoscopic treatment of gastric cancer.

7.Index type: Quality control of results.

8.Form of expression: Decreased proportion.

9.Excluded cases: None.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition)”.

Proportion of stage I-III gastric cancer patients with ≥16 lymph nodes dissected during surgical treatment

1.Index code: GC-06.

2.Index name: Proportion of stage I-III gastric cancer patients with ≥16 lymph nodes dissected during surgical treatment.

3.Definition: Proportion of stage I-III gastric cancer patients with ≥16 lymph nodes dissected during surgical treatment to all stage I-III gastric cancer patients who underwent surgical treatment.

4.Method of calculation: SeeFormula 7.

5. Patient population: Hospitalized patients and outpatients.

6.Rationale: Lymph node dissection is a major aspect of gastric cancer surgery that ensures accurate postoperative pathological staging and the achievement of radical resection,and is an important indicator of the degree of standardization of gastric cancer surgery.

7.Index type: Quality control of results.

8.Form of expression: Stable proportion.

9.Excluded cases: Patients who underwent endoscopic surgical treatment.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition)”.

Proportion of patients with metastatic gastric cancer(clinical stage IVB) who were treated surgically for the first time

1.Index code: GC-07.

2.Index name: Proportion of patients with metastatic gastric cancer (clinical stage IVB) treated with surgery for the first time.

3.Definition: Proportion of patients with metastatic gastric cancer (clinical stage IVB) who were treated surgically for the first time to all patients with metastatic gastric cancer who were treated for the first time.

4.Method of calculation: SeeFormula 8.

5. Patient population: Hospitalized patients and outpatients.

6.Rationale: A major process indicator reflecting the rationality of therapeutic decision-making and standardization of treatment for metastatic gastric cancer.

7.Index type: Quality control of the process.

8.Form of expression: Decreased proportion.

9. Excluded cases: Patients with cancer-related complications.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition)”.

Proportion of gastric cancer surgery patients who underwent preoperative nutritional risk screening and assessment

1.Index code: GC-08.

2.Index name: Proportion of gastric cancer surgery patients who underwent preoperative nutritional risk screening and assessment.

3.Definition: Proportion of gastric cancer patients treated surgically who underwent preoperative nutritional risk screening and assessment to gastric cancer patients treated by surgery.

4.Method of calculation: SeeFormula 9.

5.Patient population: Hospitalized patients.

6.Rationale: The incidence of malnutrition in gastric cancer patients is 65%-85%,which is the highest among all types of cancer. Nutritional risk screening and assessment is an important basis for guiding nutritional support treatment and an important measure to ensure the safety of gastric cancer patients during surgery.

7.Index type: Quality control of results.

8.Form of expression: Increased proportion.

9.Excluded cases: None.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition)”.

Rate of standardization of radiotherapy records of gastric cancer patients

1.Index code: GC-09.

2.Index name: Rate of standardization of radiotherapy records of gastric cancer patients.

3.Definition: Proportion of gastric cancer patients with records of radiotherapy technique,target site definition,and radiotherapy dose to all gastric cancer patients who underwent radiotherapy.

4.Method of calculation: SeeFormula 10.

5.Patient population: Hospitalized patients and outpatients.

6.Rationale: Reflects standardization of radiotherapy and is a major indicator for evaluating the likelihood of repeat radiotherapy and complications.

7.Index type: Quality control of results.

8.Form of expression: Increased proportion.

9.Excluded cases: None.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition)”.

Proportion of patients with advanced metastatic gastric cancer treated with first-line antitumor drug regimens recommended by guidelines

1.Index code: GC-10.

2.Index name: Proportion of patients with advanced metastatic gastric cancer who were treated with first-line antitumor drug regimens recommended by guidelines.

3.Definition: Proportion of patients with advanced metastatic gastric cancer (clinical stage IVB) in whom the first antitumor treatment was the first-line treatment regimen recommended by guidelines to patients with advanced metastatic gastric cancer for the first antitumor treatment.

4.Method of calculation: SeeFormula 11.

5. Patient population: Hospitalized patients and outpatients.

6.Rationale: Reflects the standardization of antitumor drug regimen selection in patients with gastric cancer.

7.Index type: Quality control of process.

8.Form of expression: Increased proportion.

9.Excluded cases: Patients with recurrence/metastasis after treatment.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition),”“Chinese Society of Clinical Oncology (CSCO) Gastric Cancer Treatment Guidelines (2021 edition)”.

Proportion of gastric cancer patients who underwent efficacy evaluation after undergoing radiotherapy or antitumor drug treatment

1.Index code: GC-11.

2.Index name: Proportion of gastric cancer patients undergoing efficacy evaluation after radiotherapy or antitumor drug treatment.

3.Definition: Proportion of gastric cancer patients who underwent efficacy evaluation after undergoing radiation therapy or antitumor drug therapy (chemotherapy,targeted therapy,immunotherapy) to gastric cancer patients who underwent radiation therapy or antitumor drug therapy.

4.Method of calculation: SeeFormula 12.

5. Patient population: Hospitalized patients and outpatients.

6.Rationale: Reflects the standardization of hospital assessment treatment and is an important indicator for evaluating the efficacy and prognosis of radiotherapy and drug therapy,and helps guide the formulation of subsequent treatment plans.

7.Index type: Quality control of results.

8.Form of expression: Increased proportion.

9.Excluded cases: None.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition)”.

Rate of standardized imaging evaluation reports of gastric cancer patients before the first treatment

1.Index code: GC-12.

2.Index name: Rate of standardized imaging evaluation reports of gastric cancer patients before the first treatment.

3.Definition: Proportion of gastric cancer patients with standardized imaging evaluation reports before the first treatment to gastric cancer patients with imaging evaluation reports before the first treatment.

4.Method of calculation: SeeFormula 13.

5.Patient population: Hospitalized patients and outpatients.

6.Rationale: Reflects standardization of diagnostic imaging reports,guides staging of gastric cancer,and forms the basis of standardized cancer treatment.

7.Index type: Quality control of results.

8.Form of expression: Increased proportion.

9.Excluded cases: Patients who already underwent lesion resection and patients with recurrence/metastasis after treatment.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition)”.

Rate of diagnosis of advanced metastatic gastric cancer patients using pathological biomarkers before the first antitumor drug treatment

1.Index code: GC-13.

2.Index name: Rate of diagnosis of advanced metastatic gastric cancer patients using pathological biomarkers before the first antitumor drug treatment.

3.Definition: Proportion of cases of diagnosis of advanced metastatic gastric cancer (clinical stage IVB) using pathological biomarker diagnosis that were performed before the first antitumor drug treatment to cases of advanced metastatic gastric cancer for the first antitumor drug treatment.

4.Method of calculation: SeeFormula 14.

5. Patient population: Hospitalized patients and outpatients.

6.Rationale: Reflects the degree of standardization of gastric cancer diagnosis and treatment,and guides the selection of first treatment strategy.

7.Index type: Quality control of results.

8.Form of expression: Increased proportion.

9.Excluded cases: Patients with recurrence/metastasis after treatment.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition),”“Chinese Society of Clinical Oncology (CSCO) Gastric Cancer Treatment Guidelines (2021 edition)”.

Quality management indices for gastric cancer

Rate of return to the operating room within 30 d after surgical treatment of gastric cancer patients

1.Index code: GC-QC-01.

2.Index name: Rate of return to the operating room within 30 d after surgical treatment of gastric cancer patients.

3.Definition: Proportion of gastric cancer patients who returned to the operating room for treatment within 30 d after undergoing surgical treatment to gastric cancer patients who underwent surgery.

4.Method of calculation: SeeFormula 15.

5.Patient population: Hospitalized patients.

6.Rationale: The rate of return to the operating room 30 d after surgical treatment is a major indicator of surgical quality and patient safety.

7.Index type: Quality control of results.

8.Form of expression: Stable proportion.

9.Excluded cases: Patients who died durng the first surgical treatment.

10.Reference evidence for index: “National Tertiary Public Hospital Performance Appraisal Operations Manual(2022 edition),” “Tertiary Hospital Level Review (2020 edition)”.

Rate of unplanned return to the hospital within 30 d after surgical treatment of gastric cancer patients

1.Index code: GC-QC-02.

2.Index name: Rate of unplanned return to the hospital within 30 d after surgical treatment of gastric cancer patients.

3.Definition: Proportion of gastric cancer patients with an unplanned return to the hospital within 30 d after undergoing surgical treatment to gastric cancer patients who underwent surgery.

4.Method of calculation: SeeFormula 16.

5.Patient population: Hospitalized patients.

6.Rationale: The rate of unplanned return to the hospital 30 d after surgical treatment is a major indicator of surgical quality and patient safety.

7.Index type: Quality control of results.

8.Form of expression: Stable proportion.

9.Excluded cases: Patients who died during the first surgical treatment and patients who were re-hospitalized for planned adjuvant treatment.

10.Reference evidence for index: “National Tertiary Public Hospital Performance Appraisal Operations Manual(2022 edition),” “Tertiary Hospital Level Review (2020 edition)”.

Five-year overall survival rate of gastric cancer patients after the first treatment

1.Index code: GC-QC-03.

2.Index name: The 5-year overall survival rate of gastric cancer patients after the first treatment.

3. Definition: The 5-year overall survival rate of hospitalized gastric cancer patients after the first treatment.

4.Method of calculation: Calculated using survival analysis.

5. Patient population: Hospitalized patients and outpatients.

6. Rationale: Reflects long-term efficacy of medical institutions in treating gastric cancer patients,and one of the most important quality control indices.

7.Index type: Quality control of results.

8.Form of expression: Increased proportion.

9.Excluded cases: None.

10. Reference evidence for index: “Gastric Cancer Diagnosis and Treatment Guidelines (2022 edition)”.

Committee of Gastric Cancer Expert Committee of National Cancer Quality Control Center,National Cancer Center

Chairman of the Committee

Jiafu JiKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Gastrointestinal Cancer Center,Peking University Cancer Hospital ＆amp;Institute

Vice Chairman of the Committee

Hui CaoDepartment of Gastrointestinal Surgery,Renjin Hospital,Shanghai Jiao Tong University School of Medicine

Changming HuangDepartment of Gastric Surgery,Fujian Medical University Union Hospital

Guoxin LiDepartment of General Surgery,Nanfang Hospital,Southern Medical University

Leping LiDepartment of Gastrointestinal Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University

Lin ShenKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Department of Gastrointestinal Oncology,Peking University Cancer Hospital ＆amp;Institute

Xian ShenDepartment of Gastrointestinal Surgery,The 2nd School of Medicine WMU

Yantao TianDepartment of Pancreatic and Gastric Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College

Zekuan XuGeneral Surgery Department of Jiangsu Provincial People’s Hospital

Committee and Secretary

Fei ShanKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Gastrointestinal Cancer Center,Peking University Cancer Hospital ＆amp;Institute

Bo ZhangDepartment of Medical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College

Committee

Yi BaDepartment of Digestive Oncology,Tianjin Medical University Cancer Institute ＆amp;Hospital

Chunmei BaiDepartment of Medical Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences/Peking Union Medical College

Zhaode BuKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Gastrointestinal Cancer Center,Peking University Cancer Hospital ＆amp;Institute

Ping CaiDepartment of Radiology,The Southwest Hospital of AMU

Ningli ChaiDepartment of Gastroenterology,Chinese PLA General Hospital

Lin ChenDepartment of General Surgery,Chinese PLA General Hospital

Luchuan ChenDepartment of Gastrointestinal Cancer,Fujian Cancer Hospital

Chao DongDepartment of Medical Oncology,Yunnan Cancer Hospital

Yalu DongDepartment of Oncology,Xinjiang Military Command General Hospital

Lixin FanDepartment of Cancer,Affiliated Zhongshan Hospital of Dalian University

Xuedong FangDepartment of General Surgery,China-Japan Union Hospital of Jilin University

Jingshu GengDepartment of Pathology,Harbin Medical University Cancer Hospital

Jianping GongDepartment of General Surgery,Tongji Hospital,Tongji Medical College of HUST

Weijian GuoDepartment of Medical Oncology,Fudan University Shanghai Cancer Center

Yifu HeDepartment of Oncology,Anhui Provincial Hospital

Yulong HeDepartment of Gastroenterology,The Seventh Affiliated Hospital,Sun Yat-sen University

Yingyong HouDepartment of Pathology,Fudan University Zhongshan Hospital

Jiankun HuDepartment of Gastrointestinal Surgery,West China Hospital,Sichuan University

Xiang HuDepartment of General Surgery,The First

Affiliated Hospital of Dalian Medical University

Yanfeng HuDepartment of General Surgery,Nanfang Hospital,Southern Medical University

Jing HuangDepartment of Medical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College

Zhigang JieDepartment of General Surgery,The First Affiliated Hospital of Nanchang University

Jing Jin Department of Radiotherapy,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College

Jun LeiDepartment of Medical Oncology,Hainan Cancer Hospital

Guoli LiDepartment of General Surgery,General Hospital of Eastern Theater Command

Jinluan LiDepartment of Radiotherapy,Fujian Cancer Hospital

Jin LiDepartment of Oncology,Shanghai Oriental HospitalMiao LiDepartment of Medical Oncology,Qinghai Cancer Province Hospital

Ran LiKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Department of Anesthesiology,Peking University Cancer Hospital ＆amp;InstituteYongheng LiKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Department of Radiotherapy,Peking University Cancer Hospital ＆amp;Institute

Yongqiang LiDepartment of Digestive Oncology,Guangxi Medical University Affiliated Tumor Hospital

Zhongwu LiKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Department of Pathology,Peking University Cancer Hospital＆amp;Institute

Ziyu LiKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Gastrointestinal Cancer Center,Peking University Cancer Hospital ＆amp;Institute

Han LiangKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Department of Gastrointestinal Oncology,Peking University Cancer Hospital ＆amp;Institute.Peking University International Hospital

Zhuan LiaoDepartment of Gastroenterology,Changhai Hospital Affiliated to Naval Medical University

Baorui LiDepartment of Oncology,Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School

Tianshu LiuDepartment of Medical Oncology,Zhongshan Hospital Fudan University

Ying LiuDepartment of Medical Oncology,Henan Cancer Hospital

Ying LiuKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Department of Pharmacy,Peking University Cancer Hospital＆amp;Institute

Zhiguo LiuDepartment of Gastroenterology,Xijing Hospital

Xianqian SuKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Gastrointestinal Cancer Center,Peking University Cancer Hospital ＆amp;Institute

Yihong SuDepartment of General Surgery,Zhongshan Hospital Fudan University

Yu SunKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Department of Pathology,Peking University Cancer Hospital＆amp;Institute

Jian SuoDepartment of Gastric and Colorectal Surgery,The First Bethune Hospital of Jilin University

Lei TangKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Department of Medical Imaging,Peking University Cancer Hospital ＆amp;Institute

Ning WangKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Beijing Office for Cancer Prevention and Control,Peking University Cancer Hospital ＆amp;Institute

Ningju WangDepartment of Medical Oncology,General Hospital of Ningxia Medical University Cancer Hospital

Wenling WangDepartment of Oncology,Guizhou Provincial People’s Hospital

Yanong WangDepartment of Gastric Surgery and Oncology,Fudan University Shanghai Cancer Center

Yanyong WangDepartment of Radiotherapy,Jilin Cancer Hospital

Yi WangDepartment of Radiology,Peking University People’s Hospital

Yusheng WangDepartment of Gastroenterology,Shanxi Cancer Hospital

Zhenning WangDepartment of Oncological Surgery,The First Hospital of China Medical University

Qi WuKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Endoscopy Center,Peking University Cancer Hospital ＆amp;Institute

Xiaojiang WuKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Gastrointestinal Cancer Center,Peking University Cancer Hospital ＆amp;Institute

Yan XinDepartment of Oncology,The First Hospital of China Medical University

Huimian XuDepartment of Oncological Surgery,The First Hospital of China Medical University

Jianming XuDepartment of Medical Oncology,Chinese PLA General Hospital

Ruihua XuDepartment of Medical Oncology,Sun Yat-sen University Cancer Center

Zekuan XuDepartment of General Surgery,Jiangsu Province Hospital

Yingwei XueDepartment of Gastrointestinal Surgery,Harbin Medical University Cancer Hospital

Min YanDepartment of General Surgery,Renjin Hospital,Shanghai Jiao Tong University School of Medicine

Yan YangDepartment of Gastroenterology,Gansu Provincial Cancer Hospital

Jieer YingDepartment of Medical Oncology,Zhejiang Cancer Hospital

Jianchun YuDepartment of Basic Surgery,Peking Union Medical College Hospital

Jiang YuDepartment of General Surgery,Nanfang Hospital,Southern Medical University

Peiwu YuDepartment of General Surgery,Southwest Hospital of AMU

Huan ZhangDepartment of Radiology,Renjin Hospital,Shanghai Jiao Tong University School of Medicine

Rong ZhangCenter for Imaging and Minimally Invasive Intervention,Department of Medical Oncology,Sun Yat-sen University Cancer Center

Ruixing ZhangDepartment of Gastroenterology,The Fourth Hospital of Hebei Medical University

Xiaotian ZhangKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),Department of Gastrointestinal Oncology,Peking University Cancer Hospital ＆amp;Institute

Yanqiao ZhangDepartment of Gastroenterology,Harbin Medical University Cancer Hospital

Yujing ZhangDepartment of Radiotherapy,Sun Yat-sen University Cancer Hospital

Zhen ZhangDepartment of Radiotherapy,Fudan University Shanghai Cancer Center

Dongbing ZhaoDepartment of Pancreatic and Gastric Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College

Guijun ZhaoEndoscopy Center of Inner Mongolia Autonomous Region People’s Hospital

Aiping ZhouDepartment of Medical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College

Yanbing ZhouDepartment of General Surgery,The Affiliated Hospital of Qingdao University

Zhiwei ZhouDepartment of Gastro-Pancreas,Sun Yat-sen University Cancer Hospital

Acknowledgements

This study was supported by “Beijing Municipal Administration of Hospitals Incubating Program” (No.PX2018043).

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.