Kim Hyoung-Il, Badgwell Brian D
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.
J Gastric Cancer. 2025 Jul;25(3):409-423. doi: 10.5230/jgc.2025.25.e36.
Peritoneal metastasis (PM) from gastric cancer is a critical determinant of poor prognosis and has limited therapeutic options. However, recent advances in diagnostic and therapeutic strategies have reshaped the clinical landscape, enabling curative treatment of select patients. Accurate staging based on the peritoneal cancer index (PCI) is central to disease stratification and treatment planning. A PCI threshold of ≤6 has emerged as a consensus-based cutoff to define peritoneal oligometastasis, a limited metastatic state with potential for long-term survival following aggressive multimodal therapy. Therefore, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy remains the cornerstone of curative treatment. Additionally, innovative peritoneum-directed therapies-including normothermic intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy, and pressurized intraperitoneal aerosol chemotherapy- have expanded the therapeutic landscape for both curative and palliative indications. This review highlights the evolving strategies for the diagnosis and treatment of gastric cancer with PM, with emphasis on PCI-based patient selection and treatment optimization. We also discuss the future roles of liquid biopsy, artificial intelligence, and photodynamic therapy in enhancing precision oncology for PM. Defining and targeting peritoneal oligometastases may enable tailored interventions and improve outcomes of this historically intractable disease.
胃癌的腹膜转移（PM）是预后不良的关键决定因素，且治疗选择有限。然而，诊断和治疗策略的最新进展重塑了临床格局，使部分患者能够接受根治性治疗。基于腹膜癌指数（PCI）的准确分期对于疾病分层和治疗规划至关重要。PCI阈值≤6已成为基于共识的界定腹膜寡转移的临界值，腹膜寡转移是一种有限的转移状态，在积极的多模式治疗后有长期生存的潜力。因此，细胞减灭术联合热灌注腹腔化疗仍然是根治性治疗的基石。此外，创新的腹膜定向治疗——包括常温腹腔化疗、术后早期腹腔化疗和加压腹腔气溶胶化疗——已扩大了根治性和姑息性适应症的治疗范围。本综述重点介绍了胃癌伴PM的诊断和治疗策略的演变，强调基于PCI的患者选择和治疗优化。我们还讨论了液体活检、人工智能和光动力疗法在提高PM精准肿瘤学方面的未来作用。界定和靶向腹膜寡转移可能实现个性化干预，并改善这种历来难以治疗的疾病的治疗效果。
