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晚期胃癌的现代治疗策略：综合评估与未来方向
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Abstract:
晚期胃癌由于其高侵袭性和快速转移特性，成为临床治疗的难题。本综述深入探讨了晚期胃癌的现代治疗策略，包括化疗、放疗、靶向疗法和免疫治疗等多种方法。在化疗方面，新型药物组合及个体化治疗方案的开发提高了治疗效果。放疗技术的创新，如强度调制放疗，提高了治疗的精准度。靶向疗法针对特定分子标志物，展示了针对性治疗的潜力，而免疫治疗则通过激活患者的免疫系统攻击癌细胞，开辟了新的治疗途径。个体化治疗策略，通过分子分型和生物标志物的识别，为患者提供了更精准的治疗选择。同时，治疗方案的定制化与优化，包括药物剂量调整和联合疗法的应用，进一步提高了治疗的有效性和安全性。此外，本文还强调了患者生活质量的管理，包括控制和缓解治疗副作用，以及提供心理支持和生活方式调整，以改善患者的整体福祉。新兴技术的探索，如生物标志物研究进展、新型药物和治疗策略的开发，以及临床试验的进行，为晚期胃癌治疗带来了新的希望和方向。总体而言，综合利用多种治疗手段，结合个体化治疗策略，是未来提高晚期胃癌患者生存率和生活质量的关键。
Advanced gastric cancer, with its high invasiveness and rapid metastatic characteristics, poses a significant challenge in clinical treatment. This review thoroughly explores modern treatment strategies for advanced gastric cancer, including chemotherapy, radiotherapy, targeted therapy, and immunotherapy. In chemotherapy, the development of new drug combinations and individualized treatment plans has improved treatment outcomes. Innovations in radiotherapy, such as intensity-modulated radiation therapy, have enhanced the precision of treatment. Targeted therapy, focusing on specific molecular markers, has shown potential for specific treatment approaches, while immunotherapy opens new therapeutic avenues by activating the patient’s immune system to attack cancer cells. Individualized treatment strategies, based on molecular profiling and biomarkers, provide more precise treatment options for patients. Additionally, the customization and optimization of treatment plans, including adjustments in drug dosages and the use of combination therapies, further enhance the effectiveness and safety of treatments. Moreover, this article emphasizes the management of patients’ quality of life, including controlling and alleviating treatment side effects, as well as providing psychological support and lifestyle adjustments to improve overall well-being. The exploration of emerging technologies, such as the progress in biomarker research, development of new drugs and treatment strategies, and clinical trials, brings new hope and directions for the treatment of advanced gastric cancer. Overall, the comprehensive use of various treatment methods combined with individualized treatment strategies is key to improving the survival rate and quality of life of patients with advanced gastric cancer.
| [1] | 左婷婷, 郑荣寿, 曾红梅, 等. 中国胃癌流行病学现状[J]. 中国肿瘤临床, 2017, 44(1): 52-58. |
| [2] | Joshi, S.S. and Badgwell, B.D. (2021) Current Treatment and Recent Progress in Gastric Cancer. CA: A Cancer Journal for Clinicians, 71, 264-279. https://doi.org/10.3322/caac.21657 |
| [3] | Wanebo, H.J., Kennedy, B.J., Chmiel, J., Steele, G., Winchester, D. and Osteen, R. (1993) Cancer of the Stomach. A Patient Care Study by the American College of Surgeons. Annals of Surgery, 218, 583-592. https://doi.org/10.1097/00000658-199321850-00002 |
| [4] | Lin, Y., Docherty, S.L., Porter, L.S. and Bailey, D.E. (2020) Common and Co-Occurring Symptoms Experienced by Patients with Gastric Cancer. Oncology Nursing Forum, 47, 187-202. https://doi.org/10.1188/20.ONF.187-202 |
| [5] | Wu, H., Wang, W., Tong, S., et al. (2015) Nucleostemin Regulates Proliferation and Migration of Gastric Cancer and Correlates with Its Malignancy. International Journal of Clinical and Experimental Medicine, 8, 17634-17643. |
| [6] | 彭智, 沈琳. 晚期胃癌综合治疗理念更新[J]. 中国实用外科杂志, 2017, 37(10): 1078-1082. https://doi.org/10.19538/j.cjps.issn1005-2208.2017.10.03 |
| [7] | 胡月新. 多西他赛联合奥沙利铂及氟尿嘧啶治疗晚期胃癌的临床研究[J]. 黑龙江医药, 2009, 22(4): 477-479. |
| [8] | Ergen, S.A., Oksüz, D.C., Karacam, S. and D？ncbas, F.O. (2021) Management of IMRT in a Gastric Cancer Patient with Pacemaker: A Case Report and Review of the Literature. Journal of Cancer Research and Therapeutics, 17, 1559-1561. https://doi.org/10.4103/jcrt.JCRT_430_19 |
| [9] | Taniguchi, H., Kimura, Y., Kim, C., Danno, K., Kagara, N., Kanoh, T., Yoshida, T., Ohnishi, T., Tohno, T., Yamada, Y., Kagawa, K., Monden, T. and Imaoka, S. (2012) Effects of Stereotactic Radiotherapy Targeting for Recurrent Gastric Cancer. Gan to Kagaku Ryoho, 39, 2313-2315. |
| [10] | Khrizman, P., Small, W., Dawson, L. and Benson, A.B. (2010) The Use of Stereotactic Body Radiation Therapy in Gastrointestinal Malignancies in Locally Advanced and Metastatic Settings. Clinical Colorectal Cancer, 9, 136-143. https://doi.org/10.3816/CCC.2010.n.018 |
| [11] | Jácome, A.A., Sankarankutty, A.K. and Dos Santos, J.S. (2015) Adjuvant Therapy for Gastric Cancer: What Have We Learned since INT0116? World Journal of Gastroenterology, 21, 3850-3859. https://doi.org/10.3748/wjg.v21.i13.3850 |
| [12] | Verma, V., Lin, S.H., Simone, C.B., et al. (2016) Clinical Outcomes and Toxicities of Proton Radiotherapy for Gastrointestinal Neoplasms: A Systematic Review. Journal of Gastrointestinal Oncology, 7, 644-664. https://doi.org/10.21037/jgo.2016.05.06 |
| [13] | Catanese, S. and Lordick, F. (2021) Targeted and Immunotherapy in the Era of Personalised Gastric Cancer Treatment. Best Practice & Research Clinical Gastroenterology, 50-51, Article ID: 101738. https://doi.org/10.1016/j.bpg.2021.101738 |
| [14] | Mitani, S. and Kawakami, H. (2020) Emerging Targeted Therapies for HER2 Positive Gastric Cancer That Can Overcome Trastuzumab Resistance. Cancers (Basel), 12, Article No. 400. https://doi.org/10.3390/cancers12020400 |
| [15] | Matsuoka, T. and Yashiro, M. (2021) Molecular-Targeted Therapy toward Precision Medicine for Gastrointestinal Caner: Current Progress and Challenges. World Journal of Gastrointestinal Oncology, 13, 366-390. https://doi.org/10.4251/wjgo.v13.i5.366 |
| [16] | Feng, R., Zhang, X. and Yang, S. (2016) Research Status Quo and Progression in Targeted Therapy for Advanced Gastric Cancer. Chinese Journal of Gastrointestinal Surgery, 19, 1191-1196. |
| [17] | Li, Y., Wang, C., Xu, M., et al. (2017) Preoperative NLR for Predicting Survival Rate after Radical Resection Combined with Adjuvant Immunotherapy with CIK and Postoperative Chemo-Therapy in Gastric Cancer. Journal of Cancer Research and Clinical Oncology, 143, 861-871. https://doi.org/10.1007/s00432-016-2330-1 |
| [18] | Wu, Y.X., Zhou, X.Y., Wang, J.Q., Chen, G.M., Chen, J.X., Wang, R.C., Huang, J.Q. and Chen, J.S. (2023) Application of Immune Checkpoint Inhibitors in Immunotherapy for Gastric Cancer. Immunotherapy, 15, 101-115. https://doi.org/10.2217/imt-2022-0080 |
| [19] | Zeng, Z., Yang, B. and Liao, Z. (2021) Progress and Prospects of Immune Checkpoint Inhibitors in Advanced Gastric Cancer. Future Oncology, 17, 1553-1569. https://doi.org/10.2217/fon-2020-0829 |
| [20] | Zhu, Y., Zhu, X., Wei, X., Tang, C. and Zhang, W. (2021) HER2-Targeted Therapies in Gastric Cancer. Biochimica et Biophysica Acta (BBA)—Reviews on Cancer, 1876, Article ID: 188549. https://doi.org/10.1016/j.bbcan.2021.188549 |
| [21] | Xing, R., Zhou, Y., Yu, J., Yu, Y., Nie, Y., Luo, W., Yang, C., Xiong, T., Wu, W.K.K., Li, Z., Bing, Y., Lin, S., Zhang, Y., Hu, Y., Li, L., Han, L., Yang, C., Huang, S., Huang, S., Zhou, R., Li, J., Wu, K., Fan, D., Tang, G., Dou, J., Zhu, Z., Ji, J., Fang, X. and Lu, Y. (2019) Whole-Genome Sequencing Reveals Novel Tandem-Duplication Hotspots and a Prognostic Mutational Signature in Gastric Cancer. Nature Communications, 10, Article No. 2037. https://doi.org/10.1038/s41467-019-09644-6 |
| [22] | Xiang, Y.Y., Deng, C.C., Liu, H.Y., Kuo, Z.C., Zhang, C.H. and He, Y.L. (2022) The Prognostic Effect of Multidisciplinary Team Intervention in Patients with Advanced Gastric Cancer. Current Oncology, 29, 1201-1212. https://doi.org/10.3390/curroncol29020102 |
| [23] | Schenk, T. and Scheithauer, W. (1993) Advances in the Prevention and Therapy of Common Chemotherapy-Induced Side Effects. Deutsche Medizinische Wochenschrift, 118, 831-837. https://doi.org/10.1055/s-2008-1059395 |
| [24] | Chung, J., Ju, G., Yang, J., Jeong, J., Jeong, Y., Choi, M.K., Kwon, J., Lee, K.H., Kim, S.T. and Han, H.S. (2018) Prevalence of and Factors Associated with Anxiety and Depression in Korean Patients with Newly Diagnosed Advanced Gastrointestinal Cancer. The Korean Journal of Internal Medicine, 33, 585-594. https://doi.org/10.3904/kjim.2016.108 |
| [25] | Breitbart, W., Rosenfeld, B., Pessin, H., Applebaum, A., Kulikowski, J. and Lichtenthal, W.G. (2015) Meaning-Centered Group Psychotherapy: An Effective Intervention for Improving Psychological Well-Being in Patients with Advanced Cancer. Journal of Clinical Oncology, 33, 749-754. https://doi.org/10.1200/JCO.2014.57.2198 |
| [26] | Bozzetti, F. (2013) Nutritional Support of the Oncology Patient. Critical Reviews in Oncology/Hematology, 87, 172-200. https://doi.org/10.1016/j.critrevonc.2013.03.006 |
| [27] | Matsuoka, T. and Yashiro, M. (2018) Biomarkers of Gastric Cancer: Current Topics and Future Perspective. World Journal of Gastroenterology, 24, 2818-2832. https://doi.org/10.3748/wjg.v24.i26.2818 |
| [28] | Yamamoto, H., Adachi, Y., Taniguchi, H., Kunimoto, H., Nosho, K., Suzuki, H. and Shinomura, Y. (2012) Interrelationship between Microsatellite Instability and MicroRNA in Gastrointestinal Cancer. World Journal of Gastroenterology, 18, 2745-2755. https://doi.org/10.3748/wjg.v18.i22.2745 |
| [29] | Onoyama, T., Ishikawa, S. and Isomoto, H. (2022) Gastric Cancer and Genomics: Review of Literature. Journal of Gastroenterology, 57, 505-516. https://doi.org/10.1007/s00535-022-01879-3 |
| [30] | Mihaljevic, A.L., Friess, H. and Schuhmacher, C. (2013) Clinical Trials in Gastric Cancer and the Future. Journal of Surgical Oncology, 107, 289-297. https://doi.org/10.1002/jso.23120 |
