中国实用外科杂志

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不可切除胰腺癌转化治疗的关键技术与评价标准

梁廷波1,乔国梁2,李    想1   

  1. 1浙江大学医学院附属第一医院肝胆胰外科 全省胰腺病研究重点实验室,浙江杭州 310003;2浙江大学附属第一医院肿瘤内科,浙江杭州 310003
  • 出版日期:2025-06-01

  • Online:2025-06-01

摘要: 不可切除胰腺癌包括局部晚期胰腺癌(LAPC)和转移性胰腺癌(MPC),通常认为不适合手术治疗,因为手术并不能改善病人的预后。近年来随着术前治疗(如化疗和放化疗)以及手术技术(如动脉,静脉重建,自体小肠移植)的发展,转化治疗的理念为部分不可切除胰腺癌病人提供了手术切除的机会。LAPC病人经过系统性治疗后手术切除的中位生存期为21.8~40.0个月,总体预后明显好于未手术组。MPC病人经过有效的系统性治疗也可以转化为手术切除治疗。尽管如此,不可切除胰腺癌的转化治疗仍面临诸多挑战,包括系统性治疗有效率不高,早期复发率高以及没有统一有效的病人筛选以及预测标准。未来随着精准医学与新型治疗手段的快速发展,通过多学科协作与持续的临床研究,转化治疗有望为更多不可切除胰腺癌病人带来生存获益。

关键词: 不可切除胰腺癌, 转化治疗, 系统性治疗, 自体小肠移植, 立体定向放疗, 局部晚期胰腺癌

Abstract: Unresectable pancreatic cancer, including locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer (MPC), is generally considered not suitable for surgical treatment, because surgery cannot improve the prognosis of patients. In recent years, with the development of preoperative treatment (such as chemotherapy and chemoradiotherapy) and surgical techniques (such as arterial, venous reconstruction, and autologous small intestine transplantation), the concept of conversion therapy provides opportunities for surgical resection for some unresectable pancreatic cancer patients. The median survival time of LAPC patients who underwent surgical resection after neoadjuvant therapy was 21.8 to 40.0 months, and the overall prognosis was significantly better than that of the non-surgical group. MPC patients can also be converted to surgical resection after effective systemic treatment. Nevertheless, the conversion therapy of unresectable pancreatic cancer still faces many challenges, including the low effective rate of neoadjuvant treatment, high early recurrence rate, and no unified and effective patient screening and prediction criteria. In the future, with the rapid development of precision medicine and new treatment methods, through multidisciplinary cooperation and continuous clinical research, conversion therapy is expected to bring survival benefits to more patients with unresectable pancreatic cancer.

Key words: unresectable pancreatic cancer, conversion therapy, systemic therapy, autologous small intestine transplantation, stereotactic body radiotherapy, locally advanced pancreatic cancer