Marrelli Daniele, Polom Karol, Neri Alessandro, Roviello Franco
Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy.
Updates Surg. 2018 Jun;70(2):225-232. doi: 10.1007/s13304-018-0546-0. Epub 2018 May 23.
Treatment options to gastric cancer (GC) have been changing in recent years from a standard to a tailored approach. Different individualized procedures can range from endoscopic resection, D2 with open or minimally invasive approach, to neo-adjuvant therapy followed by extended surgery. In more advanced stages, a combined approach with the inclusion of intraperitoneal chemo-hyperthermia (HIPEC) may represent a new advanced option. The inclusion of histological type according to Laurén classification in the flowchart of treatment could increase both accuracy and effectiveness of such tailored approach. New molecular classifications of GC have been introduced recently and translational clinical studies are ongoing. These classifications are expected to be included in multidisciplinary treatment of GC. In particular, in the group with microsatellite instability a less extended lymphadenectomy may be proposed. Also tailored neo-adjuvant treatment may be proposed according to molecular classifications. The group of patients with epithelial-to-mesenchymal transition shows very high propensity to peritoneal dissemination, as well as N-metastases, and may benefit from prophylactic HIPEC and extended lymphadenectomy when confirmed in prospective trials.
近年来，胃癌（GC）的治疗方案已从标准化方法转变为个体化方法。不同的个体化治疗程序范围广泛，从内镜切除、开放或微创入路的D2手术，到新辅助治疗后再进行扩大手术。在更晚期阶段，联合腹腔内热化疗（HIPEC）的方法可能代表一种新的晚期治疗选择。在治疗流程中纳入根据劳伦分类的组织学类型，可提高这种个体化治疗方法的准确性和有效性。最近引入了胃癌的新分子分类，相关转化临床研究正在进行中。预计这些分类将纳入胃癌的多学科治疗。特别是，对于微卫星不稳定的患者群体，可能建议进行范围较小的淋巴结清扫术。此外，也可根据分子分类建议进行个体化新辅助治疗。上皮-间质转化患者组表现出非常高的腹膜播散倾向以及N转移倾向，在前瞻性试验得到证实时，可能从预防性HIPEC和扩大淋巴结清扫术中获益。
