中国肺癌相关性恶性胸腔积液治疗进展  

Progress in treatment of lung cancer-related malignant pleural effusion in China

作　　者：侯俊杰 方艳秋[2] 杨影[2] 李孝男[2] 李晓男 米旭光 芦小单[2] 魏海峰[2] 江显卓 周颖[2] 倪志强[2] 于莹莹 金宁一(指导)[3] HOU Junjie;FANG Yanqiu;YANG Ying;LI Xiaonan;LI Xiaonan;MI Xuguang;LU Xiaodan;WEI Haifeng;JIANG Xianzhuo;ZHOU Ying;NI Zhiqiang;YU Yingying;JIN Ningyi(School of Medicine,Yanbian University,Yanji 133002,China)

机构地区：[1]延边大学医学院,延吉133002 [2]吉林省人民医院肿瘤综合治疗科,长春130021 [3]军事医学科学院分子病毒学与免疫学实验室,长春130122

出　　处：《中国免疫学杂志》2022年第2期243-248,共6页Chinese Journal of Immunology

基　　金：吉林省卫生与健康技术创新项目(2020J109);吉林省卫生健康科技能力提升项目(2021LC058)资助。

摘　　要：恶性胸腔积液(MPE)是晚期肺癌常见的症状之一,尚无有效治疗方法,严重影响患者的生活及预后。MPE的一般中位生存期为4~7个月。目前几乎所有的MPE管理指南,包括最新的2018年美国《恶性胸腔积液管理指南》,均将该病的治疗目标定为以最小的创伤来减轻或消除呼吸困难,并未谈及原发肿瘤的治疗。随着化疗、靶向治疗(EGFR、EML4-ALK/ROS1抑制剂)、生物及免疫治疗(PD-1/PD-L1和CTLA-4检查点抑制剂)等单药或多药联合治疗在肺癌治疗中的应用,肺癌治疗取得了前所未有的进展,因此仅涉及MPE自身疾病管理指南已不再适合目前的临床实践发展需求。本文就MPE的产生机制、分子靶向及免疫治疗时代下的患者个体化综合治疗策略等对肺癌相关MPE治疗进展做一综述。Malignant pleural effusion(MPE)is one of the common symptoms of advanced lung cancer. There is currently no effective treatment method,which seriously affects the quality of life and prognosis of patients. The median survival time of MPE is only 4 to 7 months. Almost all current management guidelines for MPE,including the latest "Guidelines for the Management of Malignant Pleural Effusion in 2018",set the treatment goal of the disease as alleviating or eliminating dyspnea with minimal trauma,without mentioning the treatment of the primary tumor. With the application of chemotherapy,targeted therapy(EGFR,EML4-ALK/ROS1 inhibitors),biological and immunotherapy(PD1/PDL1 and CTLA-4 inhibitors)and other single-drug or multi-drug combinations,treatment of lung cancer has made unprecedented progress. Therefore,only the MPE’s own disease management guidelines are no longer suitable for the needs of current development of clinical practice. This article reviews the progress in treatment of lung cancer-related malignant pleural effusions on the mechanism of MPE generation,molecular targeting,and patient-specific comprehensive treatment strategies in the era of immunotherapy.

关 键 词：肺癌 恶性胸腔积液 血管内皮生长因子 免疫治疗 靶向治疗 

分 类 号：R734.2[医药卫生—肿瘤]