胃癌外科精准诊疗与全程管理新思考

New perspectives on precision surgical management and whole‑course care for gastric cancer

  • 摘要: 胃癌具有显著的分子异质性、治疗反应差异大及复发风险高等特征,传统基于TNM分期和经验性治疗的管理模式难以满足精准诊疗的需求。随着分子分型、液体活检、影像组学、数字病理、多模态人工智能和基于循环肿瘤DNA的微小残留病灶监测等技术的发展,胃癌精准诊疗正由晚期疾病的“靶点‑药物匹配”逐步扩展为覆盖早期识别、精准分期、治疗选择、手术决策、术后监测和复发后再分型的全病程动态管理。笔者围绕胃癌的早期风险识别、治疗前分层、系统治疗优化、精准手术、多模态疗效预测、微小残留病灶监测及复发后动态再分型,探讨胃癌精准诊疗的临床转化路径。未来,胃癌精准诊疗的重点不在于单一技术的简单叠加,而是将分子、影像、病理和临床信息整合为可执行的临床流程,使诊断信息在关键节点转化为明确的治疗决策依据,推动胃癌管理从经验驱动走向以患者获益为核心的全病程个体化治疗。

     

    Abstract: Gastric cancer exhibits significant molecular heterogeneity, varied treatment res-ponses, and a high risk of recurrence. The traditional management model relying on TNM staging and empirical therapy is no longer sufficient to meet the demands of precision surgical management. With advances in molecular subtyping, liquid biopsy, radiomics, digital pathology, multimodal artificial intelligence, and circulating tumor DNA‑based minimal residual disease monitoring, precision oncology for gastric cancer is evolving from a "target‑drug matching" approach primarily for advanced disease to a comprehensive, dynamic management strategy covering the entire disease course, including early identification, precise staging, treatment selection, surgical decision‑making, postoperative monitoring, and molecular reclassification after recurrence. The authors discuss the clinical translation pathways for precision surgical management of gastric cancer, focusing on early risk recognition, pretreatment stratification, systemic therapy optimization, precision surgery, multimodal efficacy prediction, minimal residual disease monitoring, and dynamic molecular reclassification after recurrence. In the future, the core of precision oncology for gastric cancer will not lie in the mere accumulation of individual technologies, but in integrating molecular, imaging, pathological, and clinical information into actionable clinical workflows. This will enable diagnostic information to be translated into clear therapeutic decisions at key decision points, driving the shift from experience‑driven management to whole‑course, patient‑centered individualized decision-making that maximizes patient benefit.

     

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