ObjectiveTo summarize the research progress on the role of tumor-associated macrophages (TAMs) polarization in gastric cancer immunotherapy resistance and its pivotal signaling-regulatory mechanisms. MethodRecent domestic and international literature was systematically reviewed to summarize the distribution patterns of TAMs polarization phenotypes in the gastric cancer immune microenvironment, the mechanisms mediating immunotherapy resistance, the regulatory roles of key signaling pathways, and the TAMs-targeted intervention strategies. ResultsIn gastric cancer, TAMs are characterized by an M2-like polarization-dominant continuous spectrum with marked spatial heterogeneity; they are enriched at the invasive front and remodeled via exosomes, lactylation, and other mechanisms. TAMs polarization is finely orchestrated by multiple signaling pathways, among which the CSF1R-STAT3/PPARγ (colony stimulating factor 1 receptor/signal transducer and activator of transcription 3/peroxisome proliferator-activated receptor gamma) axis is identified as the core driver of M2 polarization, while functional imbalance is observed in the TLR-NF-κB/IRF (Toll-like receptor/nuclear factor kappa B/interferon regulatory factor) pathway within the gastric cancer microenvironment due to epigenetic alterations. Immunotherapy resistance is driven by M2-like TAMs via the establishment of immunosuppressive networks, direct suppression of CD8+ T cell effector functions, metabolic reprogramming, and other mechanisms. Notably, glycolysis induced by the IL-4/IL-4R axis and the accumulation of IRG1 (immune-responsive gene 1) / itaconate play critical roles in this process. In preclinical gastric cancer models, therapeutic strategies such as CSF1R blockade, epigenetic reprogramming (such as DNA methyltransferase inhibitor, histone methyltransferase inhibitor), and nanodrug delivery systems have been shown to reverse TAMs polarization and restore immunotherapy sensitivity, although clinical evidence specific to gastric cancer remains scarce. Furthermore, molecular subtype heterogeneity (e.g., Epstein-Barr virus-positive, hepatoid adenocarcinoma of the stomach) and TAMs subset diversity (e.g., TREM2+, IL-10+, Siglec-10+) represent critical determinants of therapeutic responsiveness. ConclusionsThe polarization status of TAMs serves as a pivotal determinant of immunotherapy resistance in gastric cancer, while its regulatory mechanisms offer novel targets for combination therapies. Future strategies should integrate molecular subtypes with dynamic biomarkers to develop personalized TAMs-targeted interventions to overcome immunotherapy resistance.
ObjectiveTo study clinical practical value of multimode imaging technique in precise hepatectomy for huge hepatocellular carcinoma (HCC). MethodsThe clinicopathologic data of patients with huge HCC who underwent precise hepatectomy in Yuebei People’s Hospital from Jan. 2018 to Dec. 2020 were collected. The three-dimensional (3D) reconstruction, 3D visualization, 3D printing, and augmented reality (AR) were used to guide preoperative evaluation, surgical planning, and surgical navigation. The liver function indexes, surgical mode, operative time, intraoperative bleeding, volume of resected liver, postoperative hospitalization, and complications were analyzed. ResultsThere were 23 patients in this study, including 18 males and 5 females, with (56.8±8.1) years old. The virtual tumor volume assessed by multimodal imaging technology was (865.2±165.6) mL and the virtual resected liver volume was (1 628.8±144.4) mL. The planned operations were anatomical hepatectomy in 19 patients and non-anatomical hepatectomy in 4 patients. The actual operation included 17 cases of anatomical hepatectomy and 6 cases of non-anatomical hepatectomy, which was basically consistent with the results of AR. The operative time was (298.4±74.5) min, the median hepatic blood flow blocking time was 20 min, and the intraoperative bleeding was (330.4±152.8) mL. Compared with preoperative levels, the levels of hemoglobin and albumin decreased temporarily on the first day after operation (P<0.05), and then which began to rise on the third day and basically rose to the normal range; prothrombintime, total bilirubin, alanine aminotransferase, and aspartate aminotransferase increased transiently on the first day after operation (P<0.05), then which began to decline to the normal levels. There were no serious operative complications and no perioperative death. The median follow-up time was 18 months, the tumor recurrence and metastasis occurred in 3 cases. ConclusionFrom preliminary results of this study, it could improve surgical safety and precision of hepatectomy for huge HCC by preoperative precise assessment and operation navigation in good time of multimode imaging technology.