免疫治疗时代下的胃癌外科

Surgical management of gastric cancer in the era of immunotherapy

随着免疫检查点抑制剂的广泛应用,化疗联合免疫治疗在多种恶性肿瘤治疗中展现出良好的效果。尤其是在胃癌治疗中,这种联合治疗策略正逐渐从晚期一线治疗拓展至围手术期治疗。相比于单纯新辅助化疗,化疗联合免疫治疗不仅可以提高病理学缓解率,还能更有效地降低肿瘤分期,特别是在人表皮生长因子受体2阳性、错配修复缺陷、PD-L1综合阳性评分≥5分、EB病毒阳性等特定亚型的胃癌患者中效果更明显。联合治疗为缩小胃切除手术范围、实施功能保留手术,甚至采取非手术治疗策略提供了可能。探索免疫治疗与化疗联合应用的最佳方案、可能的功能保留手术适应证、手术方式的改进,以及去手术策略是目前免疫治疗时代下胃癌外科的热点问题。

With the widespread application of immune checkpoint inhibitors,chemotherapy combined with immunotherapy has shown promising efficacy in the treatment of various cancers.Especially gastric cancer,this strategy is gradually expanding from first-line treatment in advanced stages to perioperative management.Compared to neoadjuvant chemotherapy alone,the combined approach not only improves pathological regression but also leads to better downstaging,which is particularly significant in gastric cancer subsets that are HER2-positive,mismatch repair deficient,PD-L1 combined positive score≥5,or EB virus-positive.This combined treatment has made it possible to reduce the extent of gastrectomy,perform function-preserving surgeries,or even consider non-surgical strategies.Currently,exploring the optimal protocols for combining immune checkpoint inhibitors with chemotherapy,identifying potential indications for function-preserving surgery,improving surgical methods,and developing non-surgical strategies represent key issues in the surgical management of gastric cancer in the era of immunotherapy.