Multiple prospective clinical studies have demonstrated that chemotherapy combined with immune checkpoint inhibitors (ICIs) can prolong the survival of patients with far-advanced gastric cancer. For patients with locally advanced gastric cancer (LAGC), preoperative neoadjuvant chemotherapy combined with immunotherapy has also achieved some encouraging results which benefit some patients, achieve clinical downstage, attenuate hidden metastases, increase R0 resection rate and reduce postoperative recurrence rate, etc. How to apply ICIs or combine immunotherapy with other therapies correctly in the course of neoadjuvant comprehensive treatment for patients with LAGC is still a very challenging and difficult problem. There are three basic principles in immunotherapy to be grasped: (1) Based on high-level clinical practice guidelines; (2) Based on the results of high-quality evidence-based medical research; and (3) Based on molecular pathology and tumor biomarkers. Perioperative immunotherapy for gastric cancer can be correctly applied if these three principles are organically integrated. Referring to the results of domestic and international clinical research in recent years, the three basic principles are demonstrated in this article for readers.
多个前瞻性临床研究业已证实化疗联合免疫检查点抑制剂能延长晚期胃癌患者的生存期。而对于局部进展期胃癌患者，开展术前新辅助化疗联合免疫治疗也已取得了初步成效，使部分患者获益，达到临床降期、减灭隐匿的转移灶、提高R0切除率、降低术后复发率等。如何在胃癌围手术期综合治疗过程中合理地应用免疫检查点抑制剂治疗，正确地将免疫治疗与其他疗法相结合以追求更好的疗效，是临床上极具挑战性的难点。免疫治疗有3项基本原则应予以把握：（1）应以高水平临床诊疗指南为基础；（2）以高质量循证医学研究结果为依据；（3）以分子病理与肿瘤生物标志物为导向，若对此3项原则做到有机统一，方能正确应用胃癌围手术期的免疫治疗。本文结合近年来国内外临床研究结果，对该3个基本原则做一阐述，以供读者参考。.