局部晚期食管鳞癌新辅助免疫治疗的研究进展
Research advances of neoadjuvant immunotherapy for locally advanced esophageal squamous cell carcinoma
尹俊 1谭黎杰1
作者信息
- 1. 复旦大学附属中山医院胸外科,上海 200032
- 折叠
摘要
近年来,免疫治疗从辅助治疗扩展到新辅助治疗,为局部晚期可切除食管鳞癌患者提供了新的治疗策略.全世界首个免疫单药新辅助治疗局部晚期食管鳞癌患者的NATION-1907研究结果显示新辅助免疫治疗可显著延长患者生存时间,减少术后复发和远处转移风险.相比传统新辅助化疗和放化疗,免疫治疗通过激活全身免疫系统,增强对肿瘤细胞的杀伤效果,且安全性和耐受性更好,为不耐受化疗或放化疗的患者提供了新的治疗选择.然而,病理学完全缓解率是否可以替代总生存时间作为主要疗效指标仍需进一步研究.与免疫单药新辅助治疗比较,免疫联合化疗或放化疗是否会给患者带来进一步生存获益目前缺乏依据.未来需要更多前瞻性研究比较不同免疫治疗方案的疗效,尤其在生物标志物指导下的个性化治疗.总体而言,新辅助免疫治疗为局部晚期食管鳞癌患者提供了新希望,但仍有未知的领域值得探索.笔者总结国内外最新研究结果并结合自身实践经验,深入阐述局部晚期食管鳞癌新辅助治疗的疗效、结局指标选择、精准治疗,旨在为食管癌免疫治疗策略的制订提供参考.
Abstract
In recent years,immunotherapy has expanded from adjuvant therapy to neoadju-vant therapy,providing new therapeutic strategies for patients with locally advanced resectable esophageal squamous cell carcinoma.The world's first study on neoadjuvant immunotherapy with a single immunotherapy agent for locally advanced esophageal squamous cell carcinoma,the NATION-1907,revealed that neoadjuvant immunotherapy can significantly extend patient survival and reduce the risk of postoperative recurrence and distant metastasis.Compared with traditional neoadjuvant chemotherapy and chemoradiotherapy,immunotherapy enhances the cytotoxic effect on tumor cells by activating the systemic immune system and shows better safety and feasibility,offering new treatment options for patients who cannot tolerate chemotherapy or chemoradio-therapy.However,whether the pathological complete response rate can replace overall survival as the primary efficacy indicator still requires further investigation.More prospective studies are needed in the future to compare the efficacy of different immunotherapy regimens,particularly personalized treatments guided by biomarkers.Overall,neoadjuvant immunotherapy offers new hope for patients with locally advanced esophageal squamous cell carcinoma,but there are unexplored areas worth investigating.Combined with practical experience,the authors summarize the latest research results at home and abroad,and elaborate on the efficacy,outcome indicator selection,and precise treatment of neoadju-vant therapy for locally advanced esophageal squamous cell carcinoma,aiming to provide reference for the clinical diagnosis and treatment of this disease.
关键词
食管肿瘤/鳞癌/新辅助治疗/免疫治疗/个体化治疗Key words
Esophageal neoplasms/Squamous cell carcinoma/Neoadjuvant therapy/Immunotherapy/Individualized therapy引用本文复制引用
基金项目
国家自然科学基金(82350127)
国家自然科学基金(82241013)
卓越外科科研项目(CESS2021TC04)
出版年
2024
NETL
NSTL
万方数据