Sundar Raghav, Nakayama Izuma, Markar Sheraz R, Shitara Kohei, van Laarhoven Hanneke W M, Janjigian Yelena Y, Smyth Elizabeth C
Department of Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Haematology-Oncology, National University Cancer Institute, Singapore.
Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
Lancet. 2025 Jun 7;405(10494):2087-2102. doi: 10.1016/S0140-6736(25)00052-2. Epub 2025 May 1.
Gastric cancer remains a major health challenge worldwide, with nearly 1 million new cases annually contributing to more than 650 000 deaths. Epidemiologically, gastric cancer shows substantial geographical variation in incidence, with higher rates in Asia, South America, and eastern Europe, and a rapid increase in early-onset cases among people younger than 50 years. Key risk factors for gastric cancer include Helicobacter pylori infection, diet, obesity, smoking, and genetic predisposition. Early detection through comprehensive diagnostic procedures is crucial for optimising treatment outcomes. Standard treatment approaches for locally advanced gastric cancer include surgical resection, particularly D2 lymphadenectomy, complemented by chemotherapy and radiotherapy. There is increasing implementation of minimally invasive surgical techniques for operable disease and integration of immune checkpoint inhibitors and targeted therapies for advanced stages. Emerging therapies, such as novel targeted treatments and next-generation immunotherapies, show promise in improving survival and quality of life. Future directions in the management of gastric cancer focus on precision medicine, continued advancement in immunotherapy, novel early detection methods, and a multidisciplinary approach to care. These strategies aim to enhance the overall effectiveness of treatment and prognosis worldwide.
胃癌仍然是全球主要的健康挑战,每年新增近100万例病例,导致超过65万人死亡。从流行病学角度来看,胃癌的发病率在地理上存在很大差异,亚洲、南美洲和东欧的发病率较高,且50岁以下人群中的早发病例呈快速上升趋势。胃癌的主要危险因素包括幽门螺杆菌感染、饮食、肥胖、吸烟和遗传易感性。通过综合诊断程序进行早期检测对于优化治疗结果至关重要。局部晚期胃癌的标准治疗方法包括手术切除,特别是D2淋巴结清扫术,并辅以化疗和放疗。对于可手术治疗的疾病,微创外科技术的应用越来越多,晚期则采用免疫检查点抑制剂和靶向治疗相结合的方法。新兴疗法(如新型靶向治疗和新一代免疫疗法)在提高生存率和生活质量方面显示出前景。胃癌管理的未来方向集中在精准医学、免疫疗法的持续进步、新型早期检测方法以及多学科护理方法。这些策略旨在提高全球治疗的整体有效性和预后。