重视胃肠道肿瘤新辅助治疗后的个体化治疗选择  

Regardinggtheselection of individualized therapyy after neoadjuvant therapy for gastrointestinal tumors

作　　者：翟建宁 雷小康 武爱文[1,2] Zhai Jianning;Lei Xiaokang;Wu Aiwen(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Gastrointestinal Cancer Center,Unit Ill,Peking University Cancer Hospital&Institute,Beijing 100142,China;State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers,Beijing Key Laboratory of Carcinogenesis and Translational Research,Gastrointestinal Cancer Center,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所、胃肠肿瘤中心三病区、恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]消化系肿瘤整合防治全国重点实验室恶性肿瘤转化研究北京市重点实验室,北京100142

出　　处：《中华胃肠外科杂志》2024年第4期338-347,共10页Chinese Journal of Gastrointestinal Surgery

基　　金：国家重点研发计划(2021YFF1201100);国家自然科学基金(82173156);北京市医院管理局扬帆计划-重点医学专业(ZYLX202116);北京大学肿瘤医院科学研究基金项目(PY202327)。

摘　　要：新辅助治疗因具有良好的肿瘤降期效果及生存获益,已被世界各大胃肠道肿瘤诊疗指南广泛推荐。新辅助治疗给传统手术治疗模式带来诸多影响,对胃癌手术的影响主要涉及手术切缘和淋巴结清扫范围的缩小,而对结直肠癌手术的影响则体现在个体化进行器官功能保留和非手术等待观察策略的实施。这些影响和改变是基于新辅助治疗的发展对局部复发的有效控制,以及大量的研究数据支持新辅助治疗在降期和生存方面的优势,同时也基于患者对器官保留和非手术治疗的意愿。另一方面,新辅助治疗模式也存在增加手术难度和术后并发症等负面影响,但整体对患者的预后影响较小。因此,在新辅助治疗后选择合适的治疗模式是需要整体的评估,特别需要注重影像学、内镜等技术手段的评估,同时有效地开展监测和随访,最后建立完善的补救机制。本文将对胃肠道肿瘤新辅助治疗后进行个体化治疗的现况和问题展开述评。Gastrointestinal tumors have been widely concerned because of increasing morbidity and mortality.In the process of exploring the therapeutic patterns of gastrointestinal tumors,patients treated with neoadjuvant therapies have good effect of tumor regression and favorable prognosis.Thus,neoadjuvant therapy strategies are recommended by major guidelines of gastrointestinal tumors in the world.Meanwhile,they have a great impact on the traditional methods of surgery,the influence mainly involves the reduction of the surgical margin and the scope of lymph node dissection in gastric cancer,while involves performing organ preservation and watch&wait in selective patients with colorectal cancer.These effects and changes were based on effective control of local recurrence by neoadjuvant therapies,and the advantages of neoadjuvant therapy in terms of tumor regression and survival supported by many studies.It is also based on the patient's desire for organ preservation and non-surgical treatment.Meanwhile,application of neoadjuvant therapy strategies increase surgical difficulty and postoperative complications,but the overall impact on patient prognosis is weak.Therefore,the selection of an appropriate treatment model after neoadjuvant therapy requires an effective overall post-treatment evaluation.In particular,it is necessary to pay attention to the evaluation of imaging,endoscopy,etc.,while effectively performing monitoring and follow-up,and finally establishing an appropriate salvage treatment.This article will review the status and problems of individualized treatment after neoadjuvant therapy of gastrointestinal tumor.

关 键 词：胃肠道肿瘤 新辅助治疗 器官保留 等待观察策略 

分 类 号：R735[医药卫生—肿瘤]