胰腺癌新辅助治疗后可切除性评估研究进展及争议  

Progress and controversy of resectability assessment for pancreatic cancer after neoadjuvant therapy

作　　者：赵姿璇 肖剑春[1] 张太平[1] 赵玉沛[1] ZHAO Zixuan;XIAO Jian-chun;ZHANG Tai-ping;ZHAO Yu-pei(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;不详)

机构地区：[1]中国医学科学院北京协和医院基本外科,北京100730 [2]清华大学医学院,北京100084

出　　处：《中国实用外科杂志》2021年第4期463-468,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.81772639,No.81802475,No.81972258,No.81974376);北京市自然科学基金(No.7192157)。

摘　　要：胰腺癌起病隐匿、进展快、预后极差,手术是可能根治胰腺癌的惟一手段,多数病人就诊时已经失去根治性手术切除机会。目前,新辅助治疗在胰腺癌综合治疗中发挥越来越重要的作用,能够使部分病人肿瘤降期,提高R0切除率。目前,主要根据病人影像学表现,结合临床症状、肿瘤标记物、全身情况等综合评估新辅助治疗后胰腺癌的可切除性。美国国家综合癌症网络(NCCN)指南推荐新辅助治疗后影像学未提示明显进展和远处转移,且CA19-9降低或稳定、临床症状有所改善的胰腺癌病人考虑进行手术切除。但由于小转移灶难以发现、影像学和病理变化不平行、检查和手术手段等局限,现有评估方法存在一定争议,导致临床工作中难以准确、客观把握手术指征。Pancreatic cancer has an insidious onset,rapid progress and a very poor prognosis.Surgical resection is the only possible way to cure pancreatic cancer,but most patients are not eligible for radical resections at diagnosis.Neoadjuvant therapy has been increasingly important in the comprehensive treatment of pancreatic cancer,which can reduce the tumor stage and increase the R0 resection rate for some patients.At present,the resectability assessment of pancreatic cancer after neoadjuvant therapy mainly rely on the patient's imaging performances,combined with clinical symptoms,the level of tumour markers and systemic conditions.As is recommended by the NCCN guideline,patients with reduced or stable levels of CA19-9 and improved clinical symptoms whose imaging doesn’t suggest significant progression or distant metastases can be considered for surgical resection.However,due to difficulties in detecting small metastases and evaluating pathological changes as well as the limitations in current examinational and surgical methods,there are still arguments about the existing assessment standards.It is still hard to accurately and objectively evaluate the surgical indications in clinical work for pancreatic cancer patients after neoadjuvant therapy.

关 键 词：胰腺癌 新辅助治疗 可切除性评估 

分 类 号：R6[医药卫生—外科学]