摘要
传统手术是直肠癌治疗的主要方法,随着免疫治疗在直肠癌治疗领域的不断深入应用,正逐步改变着低位直肠癌治疗的方式、手段甚至理念.对于错配修复功能缺陷(dMMR)/微卫星高度不稳定(MSI-H)的低位直肠癌病人,免疫治疗显示出高响应率和潜在的长期疗效.虽然免疫治疗在错配修复功能完整(pMMR)/微卫星稳定(MSS)型肿瘤中的应答率较低,但是随着研究的不断深入,包括与放疗、化疗、靶向治疗等方法联合应用,以及未来更敏感药物和生物标记物的出现,将不断提高免疫治疗的疗效从而使更多病人获得肿瘤退缩,这些成果将影响低位直肠癌的手术策略,最终达到减少手术创伤、提高保肛和器官保留率,改善生存质量和预后的目的.尽管存在诸多挑战,如适合人群选择、疗效评估、长期疗效的不确定性、治疗耐药性以及免疫治疗相关副反应等,免疫治疗仍然在低位直肠癌治疗中具有广阔的应用前景,有望为病人带来更加个体化和有效的治疗方案.
Abstract
Traditional surgery is the main method for rectal cancer treatment,and with the continuously deepening applica-tion of immunotherapy to the field of rectal cancer treatment,the way,the means,and even the concept of treating low rectal cancer are gradually evolving.For low rectal cancer patients with MSI-H/dMMR,immunotherapy has shown a high re-sponse rate and potential long-term efficacy.Although the re-sponse rate of immunotherapy in MSS/pMMR tumors is low,with the continuous deepening of research,including the com-bined application of radiotherapy,chemotherapy,targeted ther-apy,etc.,as well as the emergence of more sensitive drugs and biomarkers in the future,the efficacy of immunotherapy will continue to improve so that more patients can obtain tumor re-gression.These results will also affect the surgical strategy for low rectal cancer,ultimately achieving the reduction of surgi-cal trauma,the increased rate of anal preservation and organ preservation,and improved life quality and prognosis.Despite challenges,such as how to select a suitable population,how to accurately evaluate efficacy,the uncertainty in long-term effi-cacy,treatment resistance,and immunotherapy-related side ef-fects,immunotherapy still has a broad application prospect in the treatment of low rectal cancer and is expected to bring more personalized and effective treatment options for patients.
基金项目
上海市科学技术委员会医学引导项目(134119a3800)
国家科技期刊平台
NSTL
万方数据