摘要
免疫治疗已经成为胃癌晚期一线标准治疗。局部进展期胃癌新辅助免疫治疗正在开展临床研究。初步结果显示,与新辅助化疗比较,新辅助免疫治疗(联合化疗或联合化疗及靶向治疗或联合化疗和放疗或双免疫治疗)后患者术后病理完全缓解率获得显著提高。胃周围区域淋巴结对免疫治疗的疗效起到至关重要的作用,对于临床判断临床部分缓解(cPR)或临床完全缓解(cCR)的病例,缩小胃切除范围和淋巴结清扫范围,以免切除过多的正常淋巴结,对后续可能实施免疫治疗的疗效至关重要。免疫治疗时代,基于临床实践,应该对以手术为主时代D 2淋巴结清扫范围进行重新评估。使患者在保障手术质量的前提下,避免过度治疗,减少相关手术创伤,提高围手术期安全,改善患者的生活质量。
Immunotherapy has become the first-line standard treatment regimen for advanced gastric cancer.The neoadjuvant immunotherapy for locally advanced gastric cancer is currently undergoing clinical research.Preliminary results show that,compared with neoadjuvant chemotherapy,after neoadjuvant immunotherapy(combined with chemotherapy/combined with chemotherapy and targeted therapy/combined with chemotherapy and radiotherapy/double immunotherapy),the pathological complete response rate of patients after surgery has been significantly improved.The regional lymph nodes around the stomach play a crucial role in the curative effect of immunotherapy.For cases with clinical judgment of clinical partial response(cPR)or clinical complete response(cCR),it is import ant to appropriately reduce the scope of gastric resection and the extent of lymph node dissection to avoid excessive removal of normal lymph nodes,which is crucial for the subsequent curative effect of immunotherapy on patients.In the era of immunotherapy,based on clinical practice,the extent of D2 lymph node dissection in the era of dominated by surgery should be re-evaluated.On the premise of ensuring the quality of the surgery,this can enable patients to avoid excessive surgery,reduce relevant surgical trauma,improve the safety during the perioperative period,and enhance the patients'quality of life.
作者
梁寒
Liang Han(Department of Gastric Surgery,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin Clinical Research Center for Cancer,Tianjin Key Laboratory of Digestive System Tumors,Tianjin 300060,China)
出处
《中华胃肠外科杂志》
北大核心
2025年第9期964-968,共5页
Chinese Journal of Gastrointestinal Surgery
关键词
胃肿瘤
免疫治疗
淋巴结清扫
Stomach neoplasms
Immunotherapy
Lymph node dissection
