免疫新时代食管癌按需治疗关键问题及策略  

Key issues and strategies of on demand treatment of esophageal cancer under the new era of immunotherapy

作　　者：李志刚 Li Zhigang(Department of Thoracic Surgery,Shanghai Chest Hospital,Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200030,China)

机构地区：[1]上海市胸科医院上海交通大学医学院附属胸科医院胸外科,上海200030

出　　处：《中华消化外科杂志》2022年第10期1337-1341,共5页Chinese Journal of Digestive Surgery

基　　金：国家重点研发计划子课题(2021YFC2501005);上海申康医院发展中心三年行动计划关键支撑项目(SHDC2020CR6002)。

摘　　要：在食管癌多学科综合治疗尤其是免疫治疗广泛应用的时代,保留器官治疗旨在不影响生存的前提下改善患者生命质量。新辅助治疗后传统疗效评估手段包括经内镜活组织病理学检查及影像学评估,以上手段可以帮助完全缓解患者获得保器官治疗可能。而以循环肿瘤细胞为代表的液体活检技术是一种崭新的评估手段,未来将在多模式疗效评估中发挥重要作用并指导临床决策。保留器官治疗策略需要考虑手术窗口期、优化联合治疗手段(包括化疗方案及放疗剂量等)以获得更高的病理学完全缓解率。在免疫治疗时代,需要积极探索有效预测标志物、筛选可接受保留器官治疗的人群,针对不同人群个体化采用最佳联合治疗方案,同时增强巩固治疗强度也是免疫治疗在保留器官策略中发挥作用的重要方面。对于接受保留器官治疗的患者,需要积极主动监测,及早发现复发并进行挽救治疗。期待在免疫治疗新时代下食管癌按需治疗能够进一步发展。In the era of multidisciplinary treatment of esophageal cancer,especially the development of immunotherapy,the aim of organ-sparing treatment is to improve quality of life without reducing survival.After neoadjuvant therapy,the common efficacy evaluation methods are endoscopic biopsy and imaging examination,which may help patients with complete response obtaining organ-sparing treatment.Liquid biopsy technology represented by circulating tumor cells is a novel evaluation method,which will be used in multimodality evaluation to guide clinical decision making in the future.For organ-sparing treatment,it should consider the period of surgical window and optimization of combined treatment(chemotherapy regimens and radiation doses,etc.)to achieve a higher pathologic complete response rate.In the era of immunotherapy,it is necessary to explore effectively predictive biomarkers to identify patients who are suitable for organ-sparing treatment,and individualize the best combination therapy for different patients.At the same time,strengthening the intensity of consolidation therapy is also an important role for immunotherapy in organ-sparing treatment.Active surveillance is required to detect recurrence and implement salvage therapy for patients who received organ-sparing treatment.It is expected that the organ-sparing treatment of esophageal cancer could be developed under the new era of immunotherapy.

关 键 词：食管肿瘤 免疫治疗 保留器官 新辅助治疗 策略 

分 类 号：R735.1[医药卫生—肿瘤]