Abstract: Intratumoral clonal heterogeneity and tumor evolution have been substantiated in multiple cancer types. Gastric cancer development involves a complex process of multistage evolution and multifactorial interactions, including driver mutations and clonal evolution. Given the high mortality rate and therapeutic challenges of gastric cancer in China, this article systematically reviews the mechanisms of gastric cancer development from an evolutionary perspective, as well as advances in therapeutic research based on evolutionary theory. The paper also explores the application prospects of dynamic tumor cell evolution in clinical personalized treatment, aiming to provide a theoretical foundation for the precision therapy in gastric cancer.

Key words:  Gastric cancer, Evolution, Driver gene, Mutation, Heterogeneity, Precision therapy