Li Z Y, Jia Y N, Lu X X, Guan G M, Wang Q
Center of Gastrointestinal Tumors, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China.
Zhonghua Wai Ke Za Zhi. 2024 May 1;62(5):353-358. doi: 10.3760/cma.j.cn112139-20240220-00075.
With the widespread application of immune checkpoint inhibitors, chemotherapy combined with immunotherapy has shown promising efficacy in the treatment of various cancers. Especially gastric cancer, this strategy is gradually expanding from first-line treatment in advanced stages to perioperative management. Compared to neoadjuvant chemotherapy alone, the combined approach not only improves pathological regression but also leads to better downstaging, which is particularly significant in gastric cancer subsets that are HER2-positive, mismatch repair deficient, PD-L1 combined positive score ≥5, or EB virus-positive. This combined treatment has made it possible to reduce the extent of gastrectomy, perform function-preserving surgeries, or even consider non-surgical strategies. Currently, exploring the optimal protocols for combining immune checkpoint inhibitors with chemotherapy, identifying potential indications for function-preserving surgery, improving surgical methods, and developing non-surgical strategies represent key issues in the surgical management of gastric cancer in the era of immunotherapy.
随着免疫检查点抑制剂的广泛应用，化疗联合免疫疗法在各种癌症的治疗中已显示出有前景的疗效。尤其是在胃癌治疗中，这种策略正逐渐从晚期一线治疗扩展至围手术期管理。与单纯新辅助化疗相比，联合治疗方法不仅能改善病理退缩，还能实现更好的降期，这在人表皮生长因子受体2（HER2）阳性、错配修复缺陷、程序性死亡配体1（PD-L1）联合阳性评分≥5或EB病毒阳性的胃癌亚型中尤为显著。这种联合治疗使得减少胃切除范围、实施保留功能的手术甚至考虑非手术策略成为可能。目前，探索免疫检查点抑制剂与化疗联合的最佳方案、确定保留功能手术的潜在适应证、改进手术方法以及开发非手术策略是免疫治疗时代胃癌外科治疗中的关键问题。
