Li Jenny J, Rogers Jane E, Waters Rebecca E, Gan Qiong, Blum Murphy Mariela, Ajani Jaffer A
Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
Department of Pharmacy Clinical Program, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
Cancers (Basel). 2025 Apr 12;17(8):1307. doi: 10.3390/cancers17081307.
Upper gastrointestinal (GI) malignancies, including esophageal, gastroesophageal junction (GEJ), and gastric adenocarcinomas, remain a major global health concern, with poor overall survival and high recurrence rate despite aggressive treatment. Patients with very early tumors (cT1a) can benefit from endoscopic therapy. However, patients with locally advanced disease require multimodal therapies that may combine surgery, radiation, and systemic therapies. This review provides a comprehensive overview of recent advancements in the treatment of locally advanced upper GI adenocarcinomas. Surgical resection remains the cornerstone of curative treatment, with perioperative chemotherapy emerging as the standard of care. While preoperative chemoradiation has demonstrated some benefits in esophageal and GEJ cancers, recent data suggest a more limited role for radiation going forward. Immunotherapy has shown some promise in both the adjuvant and perioperative settings but has yet to establish definitive survival benefit. The integration of HER2-targeted therapies into treatment regimens for HER2-positive locally advanced gastroesophageal cancers has not yielded significant improvements, underscoring the need for more effective strategies. Ongoing research focuses on better predictive biomarkers, personalized treatment approaches, and potential organ preservation strategies for patients achieving a clinical complete response. Continued advancements in treatment modalities and precision medicine are critical to improving survival for patients with locally advanced upper GI adenocarcinomas.
上消化道（GI）恶性肿瘤，包括食管癌、胃食管交界（GEJ）癌和胃腺癌，仍然是全球主要的健康问题，尽管进行了积极治疗，但总体生存率低且复发率高。极早期肿瘤（cT1a）患者可从内镜治疗中获益。然而，局部晚期疾病患者需要多模式治疗，可能包括手术、放疗和全身治疗。本综述全面概述了局部晚期上消化道腺癌治疗的最新进展。手术切除仍然是根治性治疗的基石，围手术期化疗已成为标准治疗方法。虽然术前放化疗在食管癌和胃食管交界癌中已显示出一些益处，但最近的数据表明放疗在未来的作用更为有限。免疫疗法在辅助治疗和围手术期治疗中均显示出一些前景，但尚未确立明确的生存获益。将HER2靶向疗法纳入HER2阳性局部晚期胃食管癌的治疗方案中并未产生显著改善，这突出了需要更有效策略的必要性。正在进行的研究集中在更好的预测生物标志物、个性化治疗方法以及为实现临床完全缓解的患者制定潜在的器官保留策略。治疗方式和精准医学的持续进展对于提高局部晚期上消化道腺癌患者的生存率至关重要。
