胃腺癌是全球癌症死亡的主要原因。对于这种侵袭性恶性肿瘤的管理主要取决于肿瘤特征，尤其是分期。早期表浅胃癌可以通过内镜切除安全地管理，但必须获得清晰的负性深部和侧面边缘。手术切除是治疗局部晚期胃腺癌的关键部分，围手术期和辅助治疗对长期疗效有显著影响。化疗放疗仅用于手术切除不完全的患者。最近的治疗进展延长了转移性胃腺癌患者的生存期，包括使用免疫检查点抑制剂和生物标记物导向治疗。胃腺癌的靶向治疗包括针对血管内皮生长因子（VEGF）、血管内皮生长因子受体-2（VEGFR-2）和人表皮生长因子受体2（HER2）的单克隆抗体。虽然抗VEGF治疗在围手术期并没有显示出益处，但正在研究HER2靶向药物在可切除HER2阳性胃腺癌中的有效性。基于民族来源、肿瘤异质性和分期，微卫星不稳定性（MSI）在胃腺癌患者中的患病率差异很大，介于5-20%之间。MSI-high肿瘤患者围手术期化疗的作用仍有争议，而免疫治疗在初步研究中显示出有希望的结果。免疫检查点抑制剂与化疗的联合应用已经显示出改善表达程序性细胞死亡1配体1（PD-L1）的转移性胃腺癌患者预后的效果，并正在围手术期进行研究。 转自：《2023年胃肠肿瘤杂志》。保留所有权利。

Gastric adenocarcinoma is a leading cause of cancer death worldwide. The management of this aggressive malignancy largely depends on tumor characteristics especially stage. Superficial early-stage gastric cancer can be safely managed by endoscopic resection, though clear negative deep and lateral margins must be obtained. Optimal surgical resection is an essential part of the treatment for locally advanced gastric adenocarcinoma, with perioperative and adjuvant therapies having significant impact on long-term outcomes. Chemoradiation is reserved for patients with suboptimal surgical resection. Recent therapeutic advances have prolonged survival in patients with metastatic gastric adenocarcinoma, include checkpoint inhibitors and biomarker-directed therapy. Targeted therapies in gastric adenocarcinoma include monoclonal antibodies directed against vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor-2 (VEGFR-2), and human epidermal growth factor receptor 2 (HER2). While anti-VEGF therapies were not found beneficial in the perioperative setting, the effectiveness of HER2 targeted agents in resectable HER2-positive gastric adenocarcinoma is being studied. Microsatellite instability (MSI) varies greatly in patients with gastric adenocarcinoma between 5-20% based on ethnic origin, tumour heterogeneity and staging. The role chemotherapy in the perioperative setting for patients with MSI-high tumors remains controversial while immunotherapy demonstrates promising results in preliminary studies. Immune checkpoint inhibitors in combination with chemotherapy has been shown to improve outcomes in patients with metastatic gastric adenocarcinoma who express programmed cell death 1 ligand 1 (PD-L1) and is now being investigated in the perioperative setting.2023 Journal of Gastrointestinal Oncology. All rights reserved.