不可或缺,还是无足轻重--胃癌新辅助化疗争议的探讨

Indispensable or unimportant:discussion on the controversy of neoadjuvant chemotherapy for gastric cancer

胃癌是严重威胁人类健康的恶性肿瘤,由于起病隐匿、早期筛查尚未普及,我国胃癌首诊约90%属于进展期和晚期,总体5年生存率低于30%。在短期无法改变胃癌构成比的情况下,欲使我国胃癌患者5年生存率得到明显提高,很大程度上取决于如何使占比达近70%的进展期胃癌患者生存率得到提高。就某一地区而言,若手术技术水平恒定,通过有效的术前治疗降期提高根治性切除率,是最有可能提高治愈率、延长总生存时间的手段。但由于胃癌及其相关研究的异质性,对新辅助治疗尚存争议。本文回顾了胃癌新辅助化疗的关键发展历程,对其优劣势进行了梳理,探讨了当前新辅助化疗在国内外胃癌诊疗中的地位。

Gastric cancer is one of the malignant tumors threatening human health.Due to the insidious onset and the lack of early screening,90%of gastric cancer patients are in locally advanced or advanced stages when diagnosed,and the overall 5-year survival rate is less than 30%in China.For the composition ratio of gastric cancer in our country cannot be changed immediately,whether the 5-year survival rate of total patients with gastric cancer can be significantly improved depends largely on how to improve the survival rate of patients with locally advanced gastric cancer,which accounts for nearly 70%.It seems to be a feasible strategy to achieve tumor downstaging through neoadjuvant chemotherapy to increase the rate of radical resection and ultimately improve survival of locally advanced gastric cancer.However,the benefit of neoadjuvant chemotherapy remains controversial due to the heterogeneity of clinical trials and gastric cancer itself.This review summarizes the key research progress,the advantages and disadvantages of neoadjuvant chemotherapy for gastric cancer,and discusses the role of neoadjuvant chemotherapy in the treatment of gastric cancer.