肿瘤病理完全缓解的手术指征及治疗决策探讨  

Discussion on the Surgical Indications and Treatment Decisions of Pathological Complete Response in Tumors

作　　者：史文松 胡玉缀 常国涛 钱河 宋银森 杨玉伦 李向楠[2] 郑慧禹 SHI Wensong;HU Yuzhui;CHANG Guotao;QIAN He;SONG Yinsen;YANG Yulun;LI Xiangnan;ZHENG Huiyu(Department of Thoracic Surgery,The Fifth Clinical School of Henan University of Chinese Medicine/People's Hospital of Zhengzhou,Zhengzhou 450053,China;Department of Thoracic Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Geriatrics,Zhengzhou Ninth People's Hospital,Zhengzhou 450053,China;Translational Medicine Center,The Fifth Clinical School of Henan University of Chinese Medicine/People's Hospital of Zhengzhou,Zhengzhou 450053,China)

机构地区：[1]河南中医药大学第五临床医学院/郑州人民医院胸外科,河南郑州450053 [2]郑州大学第一附属医院胸外科,河南郑州450052 [3]郑州市第九人民医院老年医学科,河南郑州450053 [4]河南中医药大学第五临床医学院/郑州人民医院转化医学中心,河南郑州450053

出　　处：《医学与哲学》2024年第21期69-72,F0003,共5页Medicine and Philosophy

摘　　要：肿瘤新辅助治疗后病理完全缓解患者肿瘤组织内无残留癌细胞,预后较好,但术前评估无法精准判断,需依赖术后病理证实。这就引发了评估为临床完全缓解的患者手术适应证及临床决策的讨论。对于达到临床完全缓解的患者,并非都能实现病理完全缓解,存在复发风险。“观察等待”策略是偏保守的管理方法,需客观对待癌症治疗中的“确定性”,包容其“不确定性”,如新辅助治疗后经评估为临床完全缓解,在不影响患者生活质量的同时,综合考虑病情及患者意愿,医患共同决策下制定“观察等待”策略可作为一种可选方案。Pathological complete response(pCR)following neoadjuvant therapy for cancer refers to a state where no residual cancer cells are present within the tumor tissue.Patients achieving this status tend to have a better prognosis,but preoperative assessment cannot accurately determine this condition and relies on postoperative pathological confirmation.This has sparked discussions regarding the surgical indications and clinical decision-making for patients assessed as having a clinical complete response(cCR).Not all patients who achieve cCR will also achieve pCR,and there is a risk of recurrence.The"watch and wait(W&W)"strategy is a more conservative management approach.We must objectively address the"certainty"in cancer treatment and embrace its"uncertainty".For instance,after neoadjuvant therapy,patients assessed as cCR can consider a"W&W"strategy as an option when it does not affect the patient's quality of life,and taking into account the overall condition and patient preferences,with shared decision-making.

关 键 词：新辅助治疗 病理完全缓解 手术适应证 医患共同决策 

分 类 号：R-05[医药卫生]