From local eradication to immune priming: Paradigm shift of hyperthermic intraperitoneal chemotherapy in gastric cancer therapy

Figure 1 A roadmap for personalized decision-making in high-risk gastric cancer (e. g., pathological T4 stage). This flowchart delineates a multi-path intervention framework for high-risk gastric cancer patients, anchored in multidisciplinary team evaluation and biomarker-guided stratification. It encompasses therapeutic strategies across neoadjuvant, conversion, and adjuvant settings, proposes validation through optimized clinical trials (umbrella/platform trials), and ultimately aims to guide personalized treatment strategies to improve long-term patient outcomes. In the diagram, solid arrows indicate the core clinical decision pathway, while dashed arrows denote associated research directions. Different node shapes are used for clarity: Rectangles represent core clinical/decision points, ovals signify associated research modules, and the diamond denotes the final outcome metric. CT: Chemotherapy; HIPEC: Hyperthermic intraperitoneal chemotherapy; ICI: Immune-checkpoint inhibitor; pT4: Pathological T4.