[The paradigm shift in perioperative treatment strategies for gastric cancer in the era of precision therapy].

Advances in molecular biology and tumor immunology have propelled gastric cancer treatment into the era of precision therapy, leading to profound transformations in perioperative treatment strategies. Based on the latest clinical evidence, this article systematically elaborates on four major transformational directions in gastric cancer treatment under the precision medicine paradigm. First, the establishment of a biomarker-based precision stratification management system, where molecular markers including microsatellite instability-high, PD-L1 combined positive score, human epidermal growth factor receptor 2, and Claudin18.2 have become critical determinants in guiding immunotherapy and targeted therapy, advancing gastric cancer management from the traditional "stage-oriented" approach toward a new model that integrates both "staging and molecular subtyping". Second, the formation of a clinical decision-making model that balances both "resectability" and "disease controllability", where improved efficacy of preoperative systemic therapy provides a robust foundation for exploring function-preserving surgery, surgical extent reduction, and even surgery omission. Third, the reassessment of timing and criteria for surgical intervention following systemic therapy, with the timing of surgery after neoadjuvant treatment and the initiation of postoperative adjuvant therapy significantly impacting patient prognosis. Fourth, the gradual transition of stage Ⅳ gastric cancer toward chronic disease management, shifting treatment goals from mere palliation to long-term disease control, where quality of life is considered equally important as survival duration. Together, these transformations signify that gastric cancer treatment is moving from a traditional standardized paradigm toward a new stage of individualized precision therapy.