局部进展期胃癌的规范精准免疫治疗时代
The era of standardization, precision and immunotherapy for locally advanced gastric cancer
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摘要: 局部进展期胃癌占我国临床确诊病例数的70%,规范化淋巴结清扫是保障手术质量的根本,食管胃结合部腺癌规范化淋巴结清扫范围仍需进一步探索。保留大网膜的胃癌根治术仍需临床证据。吲哚菁绿淋巴导航是实现精准淋巴结清扫的标志。SOX(奥沙利铂+替吉奥)围手术期化疗是目前中国局部进展期胃癌的标准治疗模式,围手术期免疫+化疗正在积极探索。进入免疫治疗时代,Ⅳ期胃癌的转化治疗有望取得新突破。Abstract: Locally advanced gastric cancer accounts for 70% of clinically confirmed cases in China. Standard lymph node dissection is essential to ensure the quality of operation, and the rational lymph node dissection for adenocarcinoma of gastroesophageal junction still needs to be further explored. Radical gastrectomy with preservation of greater omentum still needs clinical evidence. Indocyanine green lymphatic navigation is a sign of accurate lymph node dissection. Peri⁃operative chemotherapy with SOX regimen (oxaliplatin and S-1) is the standard treatment for locally advanced gastric cancer in China. Perioperative immune‑chemotherapy is being actively explored. In the era of immunotherapy, the conversion therapy of stage Ⅳ gastric cancer is expected to make new breakthrough.