肿瘤免疫治疗中超进展性疾病的研究现况  

Hyperprogressive disease induced by immune checkpoint inhibitors:mechanisms and clinical implications

作　　者：桂子宸 丁则阳 张必翔[1] Gui Zichen;Ding Zeyang;Zhang Bixiang(Hepatic Surgery Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科中心,湖北武汉430030

出　　处：《腹部外科》2025年第2期156-162,共7页Journal of Abdominal Surgery

基　　金：国家自然科学基金(82472970,82273441);湖北省公共卫生青年拔尖人才项目(第一层次,2022SCZ051);华中科技大学同济医学院附属同济医院优秀青年基金项目(2020YQ05,24-2KYC13057-05)。

摘　　要：免疫检查点抑制剂的临床应用显著改善了肿瘤治疗效果,但其诱发的超进展性疾病已成为影响病人预后的关键问题。该文系统综述了超进展性疾病的研究进展,重点探讨其定义争议、潜在机制及临床管理策略。目前超进展性疾病诊断缺乏统一标准,基于肿瘤生长动力学和影像学特征的评估体系存在显著异质性,导致不同研究中发生率差异达4.8%~37.3%。分子机制研究揭示,超进展性疾病的发生与致癌通路异常、免疫微环境重塑及细胞因子失衡等多因素交互作用密切相关。该文提出建立多维度预测模型(整合临床特征、基因组标志物及影像组学),并探索靶向干预策略以优化免疫治疗决策。The clinical application of immune checkpoint inhibitors(ICIs)has significantly improved cancer treatment outcomes,yet ICI-induced hyperprogressive disease(HPD)has become a critical issue affecting the prognosis.This review systematically summarized research advances in HPD,focusing on controversies in its definition,underlying mechanisms,and clinical management strategies.Currently,the absence of unified diagnostic criteria for HPD leads to substantial heterogeneity in evaluation systems based on tumor growth kinetics and imaging characteristics,resulting in incidence variations ranging from 4.8%to 37.3%across studies.Mechanistic investigations revealed that HPD development is closely associated with multifactorial interactions involving oncogenic pathway abnormalities,immune microenvironment remodeling,and cytokine dysregulation.We proposed establishing multidimensional predictive models that integrate clinical features,genomic biomarkers,and radiomics,and exploring targeted intervention strategies to optimize immunotherapy decision-making.

关 键 词：肿瘤免疫治疗 超进展性疾病 肿瘤微环境 

分 类 号：R730[医药卫生—肿瘤]