中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

局部进展期胃癌新辅助治疗的价值、问题及对策

胡建昆，刘    凯   

  1. 四川大学华西医院普外科 胃癌中心 胃癌研究室，四川成都 610041
  • 出版日期:2024-10-01

  • Online:2024-10-01

摘要： 局部进展期胃癌（LAGC）的新辅助治疗已经成为一种常态化的治疗模式，且被欧美和我国的胃癌治疗指南所推荐。虽然新辅助治疗安全性、有效性和远期结果已被多项研究结果证实，但胃癌新辅助治疗在病例选择、化疗耐药、化疗方案优化、疗效评价体系及腹腔镜手术等方面存在诸多问题，加之新辅助治疗的疗效和远期预后预测缺少特异性的分子标记物，这些在一定程度上给LAGC新辅助治疗的应用带来困扰。尽管新辅助治疗面临许多争议，但大样本临床研究、新型药物研发、胃癌相关机制研究的深入开展和疗效评价体系的完善，有望推动新辅助治疗效果的进一步提升，其在LAGC个体化、精准化治疗的综合体系中的重要地位将进一步得到加强。

关键词: 局部进展期胃癌, 新辅助治疗, 适应症, 疗效评价, 免疫治疗

Abstract: Neoadjuvant therapy for locally advanced gastric cancer (LAGC) has become a normalized treatment mode and has been recommended by gastric cancer treatment guidelines in Europe, America, Japan, the Republic of Korea, and China. Although the safety, effectiveness, and long-term outcomes of neoadjuvant therapy for gastric cancer have been confirmed by multiple studies, there are many problems in case selection, chemotherapy resistance, chemotherapy regimen optimization, efficacy evaluation system, and laparoscopic surgery. In addition, there is a lack of specific molecular markers for the efficacy and long-term prognosis of neoadjuvant therapy, which to some extent poses challenges to the effectiveness and long-term prognosis of LAGC neoadjuvant therapy. Although neoadjuvant therapy faces many controversies, the in depth development of large scale clinical studies, new drug research, gastric cancer related mechanism studies, and the improvement of efficacy evaluation systems are expected to further enhance the effectiveness of neoadjuvant therapy. Its important position in the comprehensive system of individualized and precise treatment of LAGC will be further strengthened.

Key words: locally advanced gastric cancer neoadjuvant therapy,  , indication, efficacy evaluation, immunotherapy