The treatment strategy for locally advanced gastric cancer is at a critical juncture, transitioning from traditional perioperative chemotherapy to a paradigm of immuno-combination therapy. Low pathological complete response rate, high postoperative recurrence rate, treatment intolerances of some patients under neoadjuvant chemotherapy model are key points. In recent years, the successful application of immune checkpoint inhibitors in advanced gastric cancer has driven their shift into the perioperative setting. This article summarizes the latest clinical trial data on perioperative immunotherapy for locally advanced gastric cancer and integrates advances in both domestic and international research, and further explores precision treatment strategies based on molecular subtypes such as programmed death ligand 1, microsatellite instability-high/deficient mismatch repair, human epidermal growth factor receptor 2 and Claudin 18.2, as well as the prospects of “chemotherapy-free” and “surgery-free” approaches for microsatellite instability-high patients. The aim is to provide a comprehensive, evidence-based reference for safety challenges of perioperative immunotherapy within clinical practice and future research directions.
ObjectiveTo summary the standard treatment for early gastric cancer. MethodsThe current early gastric cancer treatment guidelines around the world were analyzed and the standardized treatment patterns for early gastric cancer were concluded. ResultsThe accurate preoperative evaluation for early gastric cancer is the basis of standardized treatment which can be divided into staging evaluation and histological evaluation.The staging evaluation is focused on the gastric wall invasion and lymph node involvement of the tumor while the histologic evaluation emphasize the histological type and grading of the tumor.According to the precise evaluation for early gastric cancer, endoscopic surgery, laparoscopic surgery, open surgery, and multimodal therapy can be applied individually to the patients.Different treatment methods have their indications, but the indications of the therapies in different guidelines are suggested with slight differences. ConclusionIn clinical practice, the choice of treatment should be made with comprehensive consideration of diagnosis and individual characteristics of patients to achieve the most benefit on prognosis.