外科理论与实践 ›› 2023, Vol. 28 ›› Issue (02): 110-114.doi: 10.16139/j.1007-9610.2023.02.05

• 专家论坛 • 上一篇    下一篇

胆囊癌新辅助治疗的现状和争议

邢颖, 程石()   

  1. 首都医科大学附属北京天坛医院普通外科,北京 100070
  • 收稿日期:2023-03-28 出版日期:2023-03-25 发布日期:2023-06-06
  • 通讯作者: 程石,E-mail: chengshi20150411@163.com

Neoadjuvant therapy for gallbladder cancer: current status and challenge

XING Ying, CHENG Shi()   

  1. Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
  • Received:2023-03-28 Online:2023-03-25 Published:2023-06-06

摘要:

胆囊癌是高度恶性的消化系统肿瘤,症状隐匿,进展快,预后差。尽管根治性切除手术是胆囊癌可能治愈的唯一方法,但多数病人确诊时已失去手术机会。近年来肿瘤的新辅助治疗已应用于许多消化系统恶性肿瘤,包括胰腺癌。胆囊癌的新辅助治疗涉及化疗、放疗、免疫治疗和分子靶向治疗。在进展期胆囊癌治疗中的病人应用,获得一定效果,使部分病人获得降期与R0切除的机会。但新辅助治疗仍面临诸多争议和挑战。如可切除性胆囊癌判断标准的不统一,无标准治疗方案,术后并发症发生率甚至高于直接手术病人,新辅助治疗的适应证和效果评估缺乏规范标准。因此,迫切需大量高质量前瞻性临床研究来解决这些争议和临床实际需要。

关键词: 胆囊癌, 新辅助治疗, 靶向治疗, 免疫治疗

Abstract:

Gallbladder cancer is one of highly malignant digestive system tumors with insidious symptoms, rapid progression, and poor prognosis. Although radical resective surgery is the only possible curative way for gallbladder cancer, most patients have lost the opportunity to undergo surgery when diagnosed. The neoadjuvant therapy had been used for many malignant tumors in digestive system including pancreatic cancer. The neoadjuvant therapy also had been used for gallbladder cancer including chemotherapy, radiation therapy, immunotherapy and molecular targeted therapy in the treatment of patients with advanced gallbladder cancer, and has achieved some effects. A few patients benefited from downstaging and got the opportunity to have R0 resection after neoadjuvant therapy. However, there are still many controversies and challenges, including the inconsistent criteria for evaluation of resectable gallbladder cancer, the absence of standardized protocols for neoadjuvant therapy, increasing rate of postoperative complications after neoadjuvant therapy compared to the patients undergoing direct surgery, and lack of criteria of both indications and evaluated effects of neoadjuvant therapy. Therefore, it should still need more high-quality prospective clinical trials to resolve these controversies and clinical applications.

Key words: Gallbladder cancer, Neoadjuvant therapy, Targeted therapy, Immunotherapy

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