局部进展期胃癌术前辅助化疗的研究进展

Progress in Preoperative Chemotherapy for Locally Advanced Gastric Cancer

术前辅助化疗是将化疗应用于根治性手术之前的综合治疗策略。胃癌的术前辅助化疗包括可切除的进展期胃癌新辅助化疗,以及临界可切除、部分不可切除进展期胃癌的术前辅助转化治疗。近十年来,随着胃癌手术标准化确立、新药开发、辅助化疗方案不断优化、多学科协作诊疗模式和系统治疗的进一步推广,进展期胃癌的治疗成绩得到显著提高。依据胃癌术前辅助化疗积累的临床证据,本文回顾了局部进展期胃癌术前辅助化疗的发展历程,探讨了胃癌术前辅助化疗的常用化疗方案及疗程、术前辅助化疗的临床应用价值、如何精准选择可能通过术前辅助化疗获益的进展期胃癌病例以及术前辅助化疗的疗效评估方法等重要问题。并对胃癌术前辅助治疗存在的问题及远景进行了展望。

Preoperative chemotherapy refered to the treatment strategies of chemotherapy before radical surgery is undertaken. In advanced gastric cancer,the notion of preoperative chemotherapy includes neoadjuvant chemotherapy for operable advanced cases and conversion therapy for the marginally resectable or partial unresectable advanced gastric cancer. In the past decade,the outcome of advanced gastric cancer has been significantly elevated by the means of operation standardization,therapeutic reagent innovation,chemotherapeutic regimen optimization,and particularly,the implementation of multidisciplinary treatment model and comprehensive therapy. Based on the accumulating clinical evidences on preoperative chemotherapy in advanced gastric cancer,we review the evolution and clinical significance of preoperative chemotherapy. We discuss the critical questions on how to accurately select the patients who may benefit from this treatment strategy,as well as the questions remaining on the precise evaluation of the treatment response.The perspective of preoperative chemotherapy in gastric cancer is also discoursed.