从全程管理角度看进展期胃癌围手术期治疗的布局与策略

Therapeutic arrangement and strategies in perioperative treatment of locally advanced gastric cancer from the view of whole-process management

我国胃癌发病率高，多数患者在确诊时即为进展期胃癌,单纯手术难达根治目的。目前已形成以手术为主，包括化疗、放疗、分子靶向治疗和免疫治疗的多学科综合治疗模式。就追求生存期延长这一终极目标而言，从全程管理的角度，进一步优化和布局围手术期治疗的策略、方法、技术和时机等．将胃癌外科手术从单纯的技术性切除提升为多学科参与的以生物学根治为目标的治疗方法，仍有较多问题亟待解决。基于循证医学证据的治疗决策和完善疗效评价标准进行富有针对性的治疗布局，同时基于基因检测的分子标志物组筛查，有助于指导合理选择药物、预测疗效和判断预后。在临床实践中，如何做到基于精准分期、明确治疗目标导向下的个体化治疗，以兼顾在缩瘤、降期、追求局部控制的基础上，切实延长患者生存期，乃是持续努力的目标。

The incidence of gastric cancer is high in China. Most patients are advanced incurable and by surgery at diagnosis. At present, the treatment of advanced gastric cancer in China has been mainly based on multidisciplinary treatment including surgery, chemotherapy, radiotherapy, molecular targeted therapy, as well as immunotherapy. In the pursuit of the ultimate goal of prolonging survival, from the perspective of management throughout the patient journey, we should further optimize and arrange the strategies, methods, techniques and timing in perioperative treatment. There are still many unsolved problems to promote gastric cancer surgery from simple technical resection to biological resection. Treatment procedure based on evidence-based medicine and efficacy evaluation criteria may result in correct decision. In addition molecular markers based on gene sequencing may help select oppropriate agents and predict efficacy and prognosis. In clinical practice, how to achieve individualized treatment based on precise staging and goal orientation is the aim of continuous efforts to prolong the survival of advanced gastric cancer patients.