胃癌新辅助治疗后病理完全缓解(pCR)的研究进展

Advances in Pathological Complete Response (pCR) after Neoadjuvant Therapy for Gastric Cancer

摘要: 胃癌作为全球范围内高发的恶性肿瘤之一，其治疗成效对患者的生存期和生活质量具有重要影响。新辅助治疗已成为胃癌综合治疗的核心环节，而病理完全缓解(pCR)是评估新辅助治疗疗效及预测患者预后的关键指标。但其定义、检测与临床解读仍缺乏统一标准。本文总结了胃癌新辅助治疗pCR的定义及评估标准、不同治疗方案对pCR率的影响、免疫标志物与pCR的关联，以及pCR与患者生存预后的相关性。研究表明，免疫联合抗血管生成药物及化疗的多药方案可使局部晚期胃癌pCR率达15.8%，且pCR患者5年总体生存率高达79.2%，显著优于非pCR患者。本文进一步探讨了pCR在指导术后辅助治疗降阶策略及作为临床试验替代终点中的应用与争议，指出构建统一的pCR评估体系、多标志物联合预测模型研发是未来核心研究方向，并开展前瞻性临床试验以验证pCR指导下的个体化治疗策略，这些将是推动胃癌精准治疗的关键方向。

Abstract: Gastric cancer is one of the most prevalent malignant tumors worldwide, and its therapeutic efficacy exerts a crucial impact on patients’ survival and quality of life. Neoadjuvant therapy has become a core component of the comprehensive treatment for gastric cancer, while pathological complete response (pCR) serves as a key indicator to evaluate the efficacy of neoadjuvant therapy and predict patient prognosis. However, unified standards for its definition, detection and clinical interpretation remain lacking. This article summarizes the definition and evaluation criteria of pCR in neoadjuvant therapy for gastric cancer, the effects of different therapeutic regimens on pCR rates, the correlation between immune biomarkers and pCR, as well as the relationship between pCR and long-term survival outcomes of patients. Studies have demonstrated that the combined regimen of immunotherapy, anti-angiogenic agents and chemotherapy can achieve a pCR rate of 15.8% in locally advanced gastric cancer. Additionally, the 5-year overall survival rate of pCR patients is as high as 79.2%, which is significantly superior to that of non-pCR patients. This paper further discusses the applications and controversies of pCR in guiding the de-escalation strategy of postoperative adjuvant therapy and acting as a surrogate endpoint in clinical trials. It points out that establishing a unified pCR evaluation system and developing multi-marker combined prediction models will be the core research directions in the future. Moreover, conducting prospective clinical trials to verify pCR-guided individualized treatment strategies is critical to advancing precision therapy for gastric cancer.