胰腺癌新辅助治疗的优势和进展

doi:10.16139/j.1007-9610.2024.01.12

摘要/Abstract

摘要：

胰腺癌由于起病隐匿、早期诊断难、恶性程度高的特点，诊断时仅有少数病人有根治性手术切除的机会。近年来，以化疗为主的术前新辅助治疗越来越多地应用于不伴远处转移的胰腺癌，帮助实现肿瘤降期、提高R0切除率并改善生存。大量临床试验证明了其优势，但仍有诸多问题需进一步研究并达成共识。

关键词: 胰腺癌, 新辅助化疗, 新辅助放化疗

Abstract:

Due to the characteristics of the insidious onset, difficult early diagnosis and high malignancy of pancrea-tic cancer, only a minority of patients still have the chance of surgical resection at the time of diagnosis. In recent years, chemotherapy-based preoperative neoadjuvant therapy has been increasingly applied to pancreatic cancer without distant metastases to help achieve tumor downstaging, increase R0 resection rate and improve patient survival. A large number of clinical trials have proven the advantages of neoadjuvant therapy for pancreatic cancer, but there are still many issues to be gradually addressed by further research to reach a consensus.

Key words: Pancreatic Cancer, Neoadjuvant chemotherapy, Neoadjuvant radiochemotherapy

中图分类号:

R735.9

胡彬蔚, 沈柏用. 胰腺癌新辅助治疗的优势和进展[J]. 外科理论与实践, 2024, 29(01): 74-80.

HU Binwei, SHEN Baiyong. Advantages and advances in neoadjuvant therapy of pancreatic cancer[J]. Journal of Surgery Concepts & Practice, 2024, 29(01): 74-80.

图/表 2

参考文献 62

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Stage	Involved vessels	NCCN 2021^[5]
Borderline resectable	CA	Head/uncinate process: tumor contacted <180° Body/tail: tumor contacted ≥180° without involvement of the aorta and with uninvolved GDA
	CHA	Tumor contacted without extension to CA or hepatic artery bifurcation allowing for safe resection and reconstruction
	SMA	Tumor contacted ≤180°
	PV/SMV	Tumor contacted >180°, contact of ≤180° with contour irregularity of the vein or thrombosis of the vein, allowing for safe and complete resection and vein reconstruction
Locally advanced	CA	Head/uncinate process: tumor contacted >180° Body/tail process: tumor contacted and aortic involvement
	SMA	Tumor contacted >180°, or 1st jejunal brunch of SMA involved
	PV/SMV	Unresconstructible because of tumor involvement or occlusion

Regimen	Treatment	Recommended group^[5]
FOLFIRINOX	Oxaliplatin + irinotecan + leucovorin + 5-fluorouracil	Good physical condition, PS 0-1
AG	Gemcitabine + nab-paclitaxel	Good physical condition, PS 0-2
GEM	Gemcitabine	Poor physical condition