引用文本：邹俊伟, 刘友东, 黄勇, 等. 胃/胃食管结合部腺癌围手术期免疫、靶向治疗再思考——基于中国临床肿瘤学会胃癌诊疗指南（2026版）更新[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(3): 352-357.

作者：邹俊伟1，刘友东2，黄勇1，陆俊2

单位：1. 皖南医科大学第二附属医院 胃肠外科，安徽 芜湖  241000；2. 复旦大学附属肿瘤医院 胃外二科，复旦大学上海医学院肿瘤学系，上海 200032

Authors：Zou Junwei1, Liu Youdong2, Huang Yong1, Lu Jun2

Unit：1. Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Wannan Medical University, Wuhu 241000, Anhui, China；2. Department of Gastric Surgery Ⅱ, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China

摘要：

2026版中国临床肿瘤学会（Chinese Society of Clinical Oncology, CSCO）胃癌诊疗指南较2025版在精准诊断和综合治疗方面作出重要修订。分子病理检测由“晚期胃癌系统治疗用药前”前移至“初诊评估及围手术期治疗”；“新辅助化疗±免疫治疗—D2根治性胃切除—辅助化疗±免疫治疗”模式纳入Ⅲ期可切除胃癌新的Ⅰ级推荐；cT_4bN_0~3M₀期胃癌患者应经多学科团队评估后，依据潜在转化切除可能性进行分层治疗。对于腹膜转移胃癌，指南在腹膜转移为唯一远处转移因素的限定条件下，强调全身治疗、腹腔化疗与手术切除的整合。上述更新表明，胃癌诊疗决策正由单一解剖学分期主导模式，转向整合分子分型、精准分期、系统治疗、外科切除及围手术期风险评估的全程管理模式。本文结合高级别循证医学证据及笔者团队开展的研究，重点对中国临床肿瘤学会胃癌诊疗指南（2026版）中有关胃癌围手术期免疫治疗前移、初始不可切除胃癌转化治疗和腹膜转移综合治疗的内容进行述评。

关键词：胃癌；中国临床肿瘤学会指南；围手术期治疗；免疫治疗；腹膜转移

Abstract：

The 2026 Chinese Society of Clinical Oncology (CSCO) guidelines for the diagnosis and treatment of gastric cancer introduce important revisions in precision diagnosis and comprehensive treatment compared with the 2025 edition. Molecular pathological testing has been advanced from “before systemic treatment for advanced gastric cancer” to “initial evaluation and perioperative treatment”. The treatment strategy of “neoadjuvant chemotherapy with or without immunotherapy, followed by D2 radical gastrectomy and adjuvant chemotherapy with or without immunotherapy” has been incorporated as a new level Ⅰ recommendation for resectable stage Ⅲ gastric cancer. For patients with cT_4bN_0-3M₀ gastric cancer, stratified treatment should be determined after multidisciplinary team evaluation according to the potential feasibility of conversion resection. For gastric cancer with peritoneal metastasis, under the condition that peritoneal metastasis is the only distant metastatic factor, the guidelines continue to emphasize the integration of systemic therapy, intraperitoneal chemotherapy, and surgical resection. These updates indicate that decision-making for gastric cancer is shifting from a model dominated by anatomical staging alone toward a full-course management strategy integrating molecular classification, accurate staging, systemic therapy, surgical resection, and perioperative risk assessment. Based on high-level evidence-based medical data and studies conducted by the authors' team, this review focuses on the updated recommendations in the 2026 CSCO guidelines regarding the advancement of perioperative immunotherapy, conversion therapy for initially unresectable gastric cancer, and comprehensive treatment for gastric cancer with peritoneal metastasis.

Key words：Gastric cancer; Chinese Society of Clinical Oncology guidelines; Perioperative treatment; Immunotherapy; Peritoneal metastasis

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