引用文本：林青雨, 戴伟钢, 李引, 等. 中国临床肿瘤学会胃癌诊疗指南（2025版）更新要点解读[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(3):299-307.

作者：林青雨，戴伟钢，李引，吴晖，翟二涛，陈剑辉，蔡世荣

单位：中山大学附属第一医院胃肠外科中心，广东 广州 510080

Authors：Lin Qingyu, Dai Weigang, Li Yin, Wu Hui, Zhai Ertao, Chen Jianhui, Cai Shirong

Unit：Gastrointestinal Surgery Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China

摘要：

胃癌是全球范围内高发且死亡率较高的消化道恶性肿瘤，尤其给我国带来了沉重的公共卫生负担。近年来，随着分子生物学、影像学、手术技术和系统治疗手段的不断进步，胃癌诊疗模式逐渐向以精准分子分型为基础的综合治疗模式转变。2025年中国临床肿瘤学会胃癌诊疗指南全面修订，紧扣最新临床研究成果和循证医学证据，更新了“可切除性再定义”“治疗方案分层化”“靶向免疫标准化”等核心理念。新版指南取消ⅣA期分期，强化多学科动态评估；调整食管胃结合部癌新辅助治疗策略，提升SOX（奥沙利铂+替吉奥）、FLOT4（氟尿嘧啶+亚叶酸钙+奥沙利铂+多西他赛）、DOS（奥沙利铂+替吉奥+多西他赛）等方案的推荐等级；同时，针对不可切除胃癌与转化治疗，明确了系统治疗在其中的主导地位，并引入腹膜转移分层管理与腹腔治疗新策略。在靶向治疗方面，人表皮生长因子受体2表达分层更加精准，德曲妥珠单抗与维迪西妥单抗拓宽了不同表达水平患者的治疗路径；Claudin18.2成为新兴关键靶点，相关检测和治疗被纳入一线推荐。免疫治疗体系全面升级，帕博利珠单抗与卡度尼利单抗联合化学治疗在不同程序性死亡受体配体1表达水平患者中展现疗效，错配修复缺陷/高微卫星不稳定亚型被确立为免疫治疗优选人群。新版指南的更新紧密结合了我国实际临床需求与国际研究进展，推动胃癌治疗进入分层管理、个体化治疗、精准干预的新阶段，为提高患者生存率和生活质量提供更为科学系统的指导依据。

关键词：胃癌；综合治疗；靶向治疗；免疫治疗；腹膜转移

Abstract：

Gastric cancer is a common and highly fatal malignancy of the digestive tract worldwide, posing a particularly significant public health burden in China. In recent years, with continuous advancements in molecular biology, imaging, surgical techniques, and systemic therapies, the treatment paradigm for gastric cancer has gradually shifted from surgery-centered local therapy to a systemic, comprehensive approach based on precise molecular subtyping. The 2025 edition of the Chinese Society of Clinical Oncology (CSCO) guidelines for the diagnosis and treatment of gastric cancer have been comprehensively revised, closely aligning with the latest clinical research findings and evidence-based medicine. The updated guidelines reflect core concepts such as “redefining resectability” “stratified treatment planning” and “standardization of targeted and immunotherapy”. Notable changes include the elimination of the ⅣA substage and an emphasis on dynamic multidisciplinary evaluation; adjustments to neoadjuvant therapy strategies for esophagogastric junction cancer with upgraded recommendations for regimens such as SOX (oxaliplatin + S-1), FLOT4 (fluorouracil + leucovorin + oxaliplatin + docetaxel), and DOS (oxaliplatin + S-1 + docetaxel); and a clarified central role of systemic therapy in unresectable gastric cancer and conversion therapy, along with the introduction of new strategies for stratified management of peritoneal metastasis and intraperitoneal treatments. In targeted therapy, human epidermal growth factor receptor 2 expression stratification has become more precise, with trastuzumab deruxtecan and disitamab vedotin expanding treatment options for patients across varying expression levels. Claudin18.2 has emerged as a key novel target, with related diagnostic and therapeutic approaches incorporated into first-line treatment recommendations. Immunotherapy has been comprehensively upgraded, with pembrolizumab and cadonilimab combined with chemotherapy showing efficacy in patients with different levels of programmed death-ligand 1 expression, and the deficient mismatch repair/microsatellite instability-high subtype being established as the preferred population for immune checkpoint inhibitors. Overall, the updated guidelines are closely aligned with the practical needs of clinical care in China while reflecting international research progress, further advancing gastric cancer treatment into a new era of stratified management, individualized treatment, and precision therapy, and providing more scientific and systematic guidance to improve patient survival and quality of life.

Key words：Gastric cancer; Comprehensive treatment; Targeted therapy; Immunotherapy; Peritoneal metastasis

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