引用文本：唐维, 蔡世荣. 2026年中国临床肿瘤学会胃癌诊疗指南药物治疗更新解读[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(3): 348-351.

作者：唐维，蔡世荣

单位：中山大学附属第一医院胃肠外科中心，广东 广州 510080

Authors：Tang Wei, Cai Shirong

Unit：Gastrointestinal Surgery Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China

摘要：

随着免疫检查点抑制剂和分子靶向药物等新型治疗手段的发展，胃癌药物治疗策略不断更新。2026年中国临床肿瘤学会（Chinese Society of Clinical Oncology, CSCO）胃癌诊疗指南结合最新循证医学证据，对局部进展期及晚期转移性胃癌的药物治疗进行了调整。本文围绕新版指南的主要更新进行解读：局部进展期胃癌新增人表皮生长因子受体2（human epidermal growth factor receptor 2, HER2）高表达患者新辅助靶向联合免疫治疗推荐；晚期转移性胃癌进一步强化程序性死亡受体配体1（programmed death-ligand 1, PD-L1）、HER2、错配修复（mismatch repair, MMR）及Claudin18.2等分子标志物检测，并更新一线免疫及靶向联合治疗和二线HER2靶向治疗推荐。上述更新体现了胃癌药物治疗正由传统化学治疗向基于生物标志物的精准治疗逐步转变。本文结合相关临床研究对上述更新的循证依据及临床意义进行分析，以期为新版指南的临床应用提供参考。

关键词：胃肿瘤；膜的解剖；系膜；淋巴结清扫；专家共识

Abstract：

With the development of immune checkpoint inhibitors and targeted drugs, treatment strategies for gastric cancer are constantly being updated. The 2026 Chinese Society of Clinical Oncology (CSCO) guidelines for gastric cancer have updated the pharmacological treatment recommendations for locally advanced and metastatic gastric cancer based on recent clinical evidence. This article reviews the major updates in the new guidelines, including the addition of neoadjuvant targeted therapy combined with immunotherapy for patients with human epidermal growth factor receptor 2 (HER2)-overexpressing locally advanced gastric cancer, and updated recommendations for biomarker testing of programmed death-ligand 1 (PD-L1), HER2, mismatch repair (MMR), and Claudin18.2, as well as first-line immunotherapy and targeted therapy combinations and second-line HER2-targeted therapy for metastatic gastric cancer. These updates reflect the gradual shift from conventional chemotherapy toward biomarker-based precision treatment. We discuss the evidence and clinical implications of these updates to provide a reference for the clinical application of the 2026 CSCO guidelines.

Key words：Gastric cancer; Chinese Society of Clinical Oncology guidelines; Precision medicine; Immunotherapy; Targeted therapy

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