中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (07): 835-840.DOI: 10.19538/j.cjps.issn1005-2208.2025.07.20

• 文献综述 • 上一篇    

胆道恶性肿瘤围手术期化疗及联合策略的进展

陈诗雨,吴向嵩,龚    伟   

  1. 上海交通大学医学院附属新华医院普外科  上海交通大学医学院胆道疾病实验室  上海市胆道疾病研究重点实验室  上海市胆道疾病研究中心,上海 200092
  • 出版日期:2025-07-01 发布日期:2025-07-27

  • Online:2025-07-01 Published:2025-07-27

摘要: 胆道恶性肿瘤(BTC)是一类高度异质且生物学行为侵袭性强的消化系统肿瘤。围手术期系统治疗可实现术前肿瘤降期、提高手术切除率,术后清除潜在微转移灶、延缓复发,已成为BTC综合管理的重要方向。以吉西他滨为基础的化疗仍是核心治疗策略,近年来,多项研究探索了新辅助治疗、转化治疗以及辅助治疗中化疗联合免疫检查点抑制剂和酪氨酸激酶抑制剂等多模式方案的疗效,部分联合方案已显示出提高R0切除率及改善生存的潜力。未来研究应完善术前与术后免疫联合方案的标准流程与疗效评价体系,基于分子分型和免疫表型实施个体化策略,并统一“边界可切除”与“不可切除”定义、开发预测生物标记物,以精准筛选获益人群、优化剂量序贯。

关键词: 胆道恶性肿瘤, 新辅助治疗, 辅助治疗, 抗肿瘤联合化疗方案

Abstract: Biliary tract cancers (BTC) constitute a highly heterogeneous group of malignancies within the digestive system, characterized by marked biological aggressiveness. Pre-operative treatment can downstage tumors and enhance resectability, whereas post-operative therapy aims to eradicate occult micrometastases and delay relapse. Gemcitabine-based chemotherapy remains the therapeutic backbone, yet recent trials evaluating multimodal regimens combining cytotoxic agents with immune-checkpoint inhibitors or tyrosine-kinase inhibitors in neoadjuvant, conversion, and adjuvant settings have shown encouraging improvements in R0 resection rates and survival outcomes. Future studies should standardize peri-operative immuno-combination protocols and response-assessment metrics, implement personalized strategies grounded in molecular subtyping and immune profiling, harmonize definitions of “borderline resectable” and “unresectable”, and develop predictive biomarkers to identify patients most likely to benefit and to optimize dosing sequences.

Key words: biliary tract neoplasms, neoadjuvant chemotherapy, adjuvant therapy, antineoplastic combined chemotherapy protocols