局部进展期胃癌新辅助治疗的现状与展望

Progress and prospects of neoadjuvant therapy in gastric surgery

胃癌是全球第五大常见恶性肿瘤和第四大肿瘤相关死亡原因。鉴于早期筛查的开展不足以及胃癌发病隐匿且进展迅速的特点, 我国胃癌患者在初诊时大部分已进入进展期。目前新辅助治疗在进展期胃癌临床诊疗中愈来愈被重视, 其能够降低肿瘤临床分期, 提高手术R0切除率及降低术后复发转移风险, 从而延长患者生存期。同时近年来, 包括本中心在内的多项临床研究表明, 新辅助化疗联合免疫治疗相较于单纯化疗, 极大提升了进展期胃癌患者的病理缓解率, 但目前仍存在一系列值得探讨的问题。笔者通过回溯国内外相关研究, 从临床及基础转化两个方向阐述进展期胃癌新辅助治疗的发展历程及目前的热点问题。

Gastric cancer is the fifth most common malignant tumor and the fourth leading cause of cancer-related deaths worldwide.Due to the insufficient implementation of early screening and the insidious and rapid progression of gastric cancer,most gastric cancer patients in China have entered the stage of progression at the initial diagnosis.At present,neoadjuvant therapy is increasingly valued in the clinical diagnosis and treatment of advanced gastric cancer.It can reduce tumor clinical staging,improve surgical R0 resection rate,and reduce the risk of postoperative recurrence and metastasis,thereby prolonging patient survival.In recent years,multiple clinical studies including our center have shown that neoadjuvant chemotherapy combined with immunotherapy significantly improves the pathological response rate of advanced gastric cancer patients compared to chemotherapy alone.However,there are still a series of issues worth exploring.The author elaborates on the development process and current hot topics of neoadjuvant therapy for advanced gastric cancer from two perspectives:clinical and basic transformation,by reviewing relevant research both domestically and internationally.