Spatiotemporal Multi-Omics Landscape of PerioperativeImmune Microenvironment Remodeling in Gastric Cancer—Leading the Way to Personalized Therapy
PENG Shixuan, JIA Fangzhou, GAO Xiangyu*
The heterogeneity of GC (gastric cancer) poses a significant challenge to the traditional TNMstaging system in predicting perioperative immune responses. This review aims to dissect the mechanisms of dynamic microenvironmental remodeling in GC from a spatiotemporal multi-omics perspective and explore its pivotalrole in guiding personalized therapy. This review highlights how AI-driven digital pathology integrated with epitranscriptomic regulation reveals spatial immune escape signatures and cellular fate decisions. Evidence suggeststhat perioperative chemotherapy combined with immunotherapy facilitates a phenotypic transition from “cold” to“hot” tumors by reprogramming the tumor microenvironment. Furthermore, this review discusses the central rolesof hypoxia-induced exosomal communication and cuproptosis-related metabolic profiles in mediating cross-scalecellular crosstalk, alongside the utility of predictive models in quantifying therapeutic efficacy. By integrating frontier technologies—including multimodal longitudinal serological monitoring, refined lymph node staging systems,and molecular imaging guidance—this review emphasizes the necessity of constructing a comprehensive, multidimensional monitoring framework. This review provides a systematic theoretical foundation for advancing GCmanagement from empirical intervention toward a precision personalized paradigm.
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