胰腺癌新辅助化疗后可切除性评估现状及进展  

Current status and progress in assessment of resectability of pancreatic cancer after neoadjuvant chemotherapy

作　　者：张昊 潘卫东 Zhang Hao;Pan Weidong(Department of General Surgery(Department of Hepato-Biliary-Pancreatic Surgery),the Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510655,China;Biomedical Innovation Institute of the Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院普通外科(胰腺肝胆外科),广州510655 [2]广州市黄埔区中山六院生物医学创新研究院,510655

出　　处：《中华肝脏外科手术学电子杂志》2024年第5期629-633,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家临床重点专科;广东省消化系统疾病临床医学研究中心项目(2020B1111170004)

摘　　要：胰腺癌是预后最差的肿瘤之一,R0手术切除是患者获得长期生存的唯一方式。为提高R0切除率,美国国立综合癌症网络(NCCN)指南建议对临界可切除及局部进展期患者优先行新辅助化疗。但新辅助化疗后,尤其是临界可切除患者的肿瘤可切除性评估给外科医师带来不小的困难。CT及MRI都存在低估肿瘤可切除性的倾向。建议动态检测CA19-9、评估影像学资料及患者全身一般情况、MDT讨论患者手术能否获益。必要时,依据患者个体情况行PET-CT、二代测序、循环肿瘤DNA检测协助判断。随着影像组学、人工智能(AI)阅片、基因检测、液体活检等临床证据的不断完善,外科医师将对肿瘤可切除性做出更加精准的预判。Pancreatic cancer is one of the tumors with the worst prognosis.R0 resection is the only option to achieve long-term survival.To improve the R0 resection rate,National Comprehensive Cancer Network(NCCN)guidelines recommends neoadjuvant chemotherapy for borderline resectable and locally advanced stage patients.However,the assessment of tumor resectability after neoadjuvant chemotherapy,especially in borderline resectable patients,brings huge challenges to surgeons.Both CT and MRI tend to underestimate the resectability of tumors.Dynamic detection of CA19-9,evaluation of imaging data and general condition and MDT consultation are recommended to evaluate whether patients can benefit from surgery.PET-CT,next-generation sequencing and circulating tumor DNA detection should be performed to assist diagnosis when necessary according to the individual conditions of patients.With persistent advancement of clinical evidence such as imaging,artificial intelligence(AI)-assisted film reading,genetic testing and liquid biopsy,surgeons will deliver more accurate prediction for tumor resectability.

关 键 词：胰腺肿瘤 胰腺导管腺癌 新辅助化疗 可切除性 

分 类 号：R735.9[医药卫生—肿瘤]