Gastric cancer remains the second most common malignancy worldwide. Surgical resection with D2 lymph node dissection is the standard of care in localized gastric cancer. However about 40% of patients in East Asia and 70% of patients in Western countries experience recurrence after curative surgical resection of localized gastric cancer. Once recurrence occurs, the prognosis of patients is usually dismal, especially in case of distant metastases. Although many clinical trials of adjuvant

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... t were conducted to reduce recurrence of gastric cancer after surgical resection, it was controversial until early 2000s whether adjuvant treatment could improve recurrence-free survival or overall survival in gastric cancer. In early 2000s, adjuvant chemoradiation became the standard of care in the US based on the results of SWOG 9008/INT 0116 trial, where only minor portion of patients underwent D2 lymph node dissection. However, adjuvant chemoradiation was considered not applicable to patients with gastric cancer in East Asia where D2 lymph node dissection is the standard surgical method. Recently, large scale phase III studies including ACTS-GC and CLASSIC trial were conducted in the East Asia. Based on those studies, adjuvant chemotherapy is currently accepted as standard treatment in gastric cancer in the East Asia. ( Korean J Med 2012;83:291-296) 서 론 우리나라에서 위암은 갑상선암에 이어서 두 번째로 많이 발생하는 암으로 매년 약 3만 명 이상의 환자가 발생하며, 폐암, 간암에 이어 세 번째로 치사율이 높아 매년 약 1만 명 이상의 환자가 사망한다[1]. 위암에서 수술 후 보조항암화학요법의 역할에 대해서는 개별 연구들에 있어 국소 치료로 적용된 수술 방법의 적절 성, 이질적인 특성을 보이는 하부 식도암 및 위식도 접합부 종양의 포함 여부, 비현실적 치료 성적의 차이를 가정한 표 본수의 산정 등의 이유로 2000년 대 중반까지 많은 논란이 있어 왔다.