多学科视角下食管胃结合部癌治疗的热点和进展

Hot topics and advances in the treatment of esophagogastric junction cancer from a multidis-ciplinary perspective

  • 摘要: 2025年第16届国际胃癌大会(IGCC)聚焦食管胃结合部癌(EGJC)的治疗研究进展。肿瘤内科强调EGJC独特的分子分型对预后和治疗选择的重要性。新辅助治疗后最佳手术时机、主动监测策略、围手术期化疗与新辅助放化疗的选择、免疫治疗及靶向治疗的探索,均成为近期研究热点。ESOPEC等研究结果提示:围手术期FLOT方案化疗优于传统放化疗,且联合免疫治疗正展现出提高病理学缓解率和改善生存的潜力。外科视角下,食管胃结合部腺癌(AEG)定义的再讨论与手术策略优化仍在研究中,尤其是Siewert Ⅱ型AEG手术入路及纵隔淋巴结清扫范围尚存争议。欧洲的TIGER研究结果值得期待。笔者单位牵头开展的CLASS‑10研究也将为AEG淋巴结清扫策略的制订增补循证医学证据。笔者深入介绍多学科视角下EGJC诊疗策略,展现EGJC的独特性对临床研究和实践提出的挑战;提出未来应对其异质性基于分子与解剖学分型开展更精准的临床试验,以推动个体化治疗策略的制订。

     

    Abstract: The 16th International Gastric Cancer Congress (IGCC 2025) highlighted advances in the treatment of esophagogastric junction cancer (EGJC). From a medical oncology perspective, the unique molecular subtypes of EGJC are critical for prognosis and therapeutic decision‑making. Key research topics include the optimal time to surgery after neoadjuvant therapy, active survei-llance strategies, comparisons between perioperative chemotherapy and neoadjuvant chemoradio-therapy, and the exploration of immunotherapy and targeted therapy. Recent studies, such as ESOPEC, demonstrated that perioperative chemotherapy with the FLOT regimen is superior to conventional chemoradiotherapy, while immunotherapy shows promise in improving pathological response and survival outcomes. From the surgical perspective, ongoing debates focus on redefining adenocarcinoma of esophagogastric junction (AEG) classification and optimizing surgical strategies, particularly regarding approaches and mediastinal lymphadenectomy for Siewert Ⅱ AEG. Results from the European TIGER study are eagerly awaited, and the CLASS‑10 trial led by our institution is expected to provide high‑level evidence to guide lymphadenectomy strategies in AEG. The authors provide an in‑depth introduction to the diagnosis and treatment strategies of EGJC from a multi-disciplinary perspective, highlighting the challenges posed by the uniqueness of EGJC to research and clinical practice. Future efforts should emphasize controlling heterogeneity and designing precise clinical trials based on molecular and anatomical classifications to promote individualized treatment strategies.

     

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