引用文本：黄凯铧，赵丽瑛. 局部进展期胃癌围手术期免疫治疗的进展与临床实践再思考[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(2): 217-224.

作者：黄凯铧，赵丽瑛

单位：南方医科大学南方医院普外科，广东 广州 510410

Authors：Huang Kaihua, Zhao Liying

Unit：Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510410, Guangdong, China

摘要：

近年来，免疫治疗在胃癌治疗领域取得重要进展，其应用已由晚期治疗前移至可切除局部进展期胃癌（locally advanced gastric cancer, LAGC）的围手术期治疗。多项Ⅲ期随机对照试验表明，围手术期免疫治疗可提高LAGC的病理完全缓解率并改善无事件生存；MATTERHORN研究证实了围手术期免疫治疗的生存获益，标志着围手术期免疫治疗开始重塑LAGC的综合治疗模式。与此同时，围手术期免疫治疗的临床关注重点亦由“能否应用”转向“如何更加精准、合理地应用”，主要包括优势获益人群的精准筛选、围手术期安全性的有效管理、术后治疗策略的优化，以及新辅助免疫治疗背景下外科策略的再评估。在围手术期免疫治疗快速发展并逐步成为LAGC新标准治疗方案的背景下，有必要对现有研究进展进行系统梳理，并对未来临床实践中的关键问题作进一步思考与展望。

关键词：局部进展期胃癌；围手术期治疗；免疫治疗；精准治疗；D2淋巴结清扫

Abstract：

In recent years, immunotherapy has made substantial progress in the treatment of gastric cancer, with its application shifting from advanced disease to the perioperative setting for resectable locally advanced gastric cancer (LAGC). Multiple phase Ⅲ randomized controlled trials have shown that perioperative immunotherapy can increase the pathological complete response rate and improve event-free survival in patients with LAGC. The MATTERHORN study further demonstrated a survival benefit, marking the beginning of a reshaping of the comprehensive treatment paradigm for LAGC. Meanwhile, the clinical focus of perioperative immunotherapy has shifted from "whether to use it" to "how to apply it more precisely and appropriately", mainly involving precise identification of patients most likely to benefit, effective perioperative safety management, optimization of postoperative treatment strategies, and re-evaluation of surgical strategies in the setting of neoadjuvant immunotherapy. Against the background of the rapid development of perioperative immunotherapy and its emergence as a new standard of care for LAGC, it is necessary to systematically review current advances and further consider the key issues in future clinical practice.

Key words：Locally advanced gastric cancer；Perioperative care；Immunotherapy；Precision medicine；D2 lymphadenectomy

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