新辅助治疗在胆道恶性肿瘤治疗模式改变中的价值  

The value of neoadjuvant therapy in changing the treatment mode of biliary tract cancers

作　　者：张晓飞 崔玖洁[1] 刘颖斌 ZHANG Xiaofei;CUI Jiu-jie;LIU Ying-bin(Cancer Center and Department of Biliary and Pancreatic Surgery,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai Cancer Institute,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院肿瘤中心/胆胰外科、上海市肿瘤研究所,上海200127

出　　处：《中国实用外科杂志》2023年第3期304-309,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金重点项目(No.32130036);上海市科委基础重点项目(No.20JC1419100)。

摘　　要：胆道癌(BTCs)是一种发生于胆道系统、恶性程度极高的恶性肿瘤,手术切除是BTCs唯一潜在治愈的治疗选择,但仅少数病人具有手术切除机会。另外,近50%病人在诊断时认为可切除,剖腹探查中却无法达到R0切除,且R0切除术后,病人的复发率仍然很高,因此,胆道癌整体预后极差。近年来,新辅助治疗在多个瘤种中取得巨大进展,具有术前降期、提高R0切除率、减少术后复发及远处转移风险和提高生存率的作用,改变了肿瘤的治疗模式。BTCs新辅助治疗已开展多项探索性研究,但缺乏大样本、前瞻性、随机对照研究,且存在一些问题尚未解决,包括新辅助治疗的确切疗效、最佳治疗周期数和时间、术后辅助治疗的选择等。与单纯手术相比,新辅助治疗联合手术具有更长的总生存期,但需要进一步开展前瞻性随机对照的临床研究进行验证,以确定优选的治疗方案以及人群,也为临床使用提供更为明确的循证医学证据。Biliary tract cancer(BTCs)is a highly malignant tumor that occurs in the biliary system.Surgical resection is the only potential cure option for BTCs,but only a few patients have the opportunity for surgical resection.In addition,nearly 50%of patients were considered resectable at the time of diagnosis,but failed to achieve R0 resection during exploratory laparotomy,and the recurrence rate of patients cholangiocarcinoma was very poor. In recent years,neoadjuvant therapy has made great progress in many tumortypes, which has the effect of lowering the stage before surgery,improving the R0 resection rate, reducing the risk ofpostoperative recurrence and distant metastasis and improvingthe survival rate, and has changed the treatment mode of thetumor. Many exploratory studies have been carried out on theneoadjuvant therapy of BTCs, but there is a lack of largesample, prospective,randomized controlled studies, and thereare still some problems that have not been solved, includingthe exact efficacy of neoadjuvant therapy, the optimal numberand time of treatment cycles, and the choice of postoperativeadjuvant therapy. Compared with surgery alone, neoadjuvanttherapy combined with surgery has a longer overall survival,but further prospective randomized controlled clinical studiesare needed for verification to determine the optimal treatmentplan and population, and to provide more clear information forclinical use. evidence-based medicine.

关 键 词：胆道癌 新辅助治疗 新辅助放化疗 治疗模式 

分 类 号：R6[医药卫生—外科学]