胰腺癌新辅助治疗和转化治疗的现状与展望

Current status and prospects of neoadjuvant and conversion therapy for pancreatic cancer

摘要:

胰腺癌手术切除率低，预后极差。近年来，随着新型药物的出现、治疗手段的多样化及多学科诊疗模式的发展，胰腺癌的新辅助治疗与转化治疗引起了广泛的关注。本文系统梳理了新辅助治疗和转化治疗在胰腺癌中的临床应用以及转化治疗后手术时机的选择，提出将可切除型胰腺癌分为低风险组和高风险组。低风险组患者推荐优先手术切除，高风险组与交界性可切除胰腺癌患者直接手术R0切除率较低，行新辅助治疗后，可明显提高R0切除率。对于不可切除胰腺癌患者应综合评估能否行转化治疗，部分转化有效患者可行根治性手术。然而，胰腺癌新辅助治疗与转化治疗方案的选择、治疗周期及术后辅助方案等问题目前尚无共识。相信伴随高级别循证医学证据的出现，新辅助治疗和转化治疗将在胰腺癌治疗中得到更广泛的应用。

Abstract:

Pancreatic cancer has a low surgical resection rate and a very poor prognosis. In recent years, with the emergence of new drugs, the diversification of treatment methods, the development of multidisciplinary diagnosis and treatment models, neoadjuvant treatment and translational treatment of pancreatic cancer have attracted widespread attention. This article systematically sorts out the clinical application of neoadjuvant therapy and translational therapy in pancreatic cancer, as well as the timing of surgery after translational therapy, and proposes to divide resectable pancreatic cancer into low-risk groups and high-risk groups. Patients in the low-risk groups are recommended to prioritize surgical resection. The high-risk groups and patients with borderline resectable pancreatic cancer have a lower rate of R0 resection. Neoadjuvant therapy can significantly increase the rate of R0 resection. For patients with unresectable pancreatic cancer, a comprehensive assessment should be made on whether conversion therapy can be performed, and radical surgery is feasible for some effective patients. However, there is no consensus on the selection of neoadjuvant treatment and translational treatment for pancreatic cancer, the treatment cycle, and postoperative adjuvant options. It is believed that with the emergence of highlevel evidence-based medicine, neoadjuvant therapy and conversion therapy will be more widely used in the treatment of pancreatic cancer.