局部进展期胃癌围手术期治疗的现状与展望

在我国，每年新增的胃癌患者中，局部进展期胃癌（LAGC）占大宗。D 2根治性手术及其术后辅助化疗已取得了普遍的共识，该治疗策略明显改善了LAGC患者的预后，但是术后复发率仍然较高（50%~80%），致使远期疗效难以进一步提高。围手术期治疗，特别是术前新辅助治疗（NAT）能否提高LAGC疗效，已受到越来越多的关...

Current status and prospect of perioperative therapy for locally advanced gastric cancer

Local advanced gastric cancer(LAGC)accounts for a large proportion of annual newly diagnosed gastric cancer patients in China.There is a general consensus for D2 radical gastrectomy followed by postoperative adjuvant chemotherapy for LAGC patients,and this therapeutic strategy has been confirmed by a series of clinical trials to obviously improve the patients'prognosis;however,the recurrence rate is still high(about 50%-80%in advanced stage),which makes it difficult to further improve the long-term survival.Perioperative therapy,especially whether preoperative neoadjuvant therapy(NAT)can improve the efficacy of patients with LAGC,has been paid more and more attention.NAT is mainly defined as a preoperative chemotherapy or chemoradiotherapy,aiming at increasing curative resection rate by downstaging tumor,eliminating micrometastases,and autologously testing of anti-cancer drug sensitivity etc.However,there are still some controversy whether LAGC patients could gain survival benefit from NAT and also lack of general consensus for this issue.In this paper,the author reviews and analyzes the current situation of perioperative therapies for LAGC patients,especially emphasize the results of neoadjuvant chemotherapy or chemoradiotherapy reported by various high-level clinical studies.The preliminary effect of perioperative chemotherapy combined with molecular targeted or immunotherapy has also aroused great interest and attention.While we continue to carry out NAT and look forward to more new high-level evidence trials on NAT,we must emphasize again that R0 gastrectomy remains the most important therapeutic modality for the patients with LAGC.