中国实用外科杂志

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胰腺癌肝转移的局部与全身治疗策略

康晓超,王    欢,郭世伟,金    钢   

  1. 海军军医大学第一附属医院(上海长海医院)肝胆胰脾外科,上海 200433
  • 出版日期:2025-06-01

  • Online:2025-06-01

摘要: 肝脏是胰腺癌最常见的转移部位,胰腺癌肝转移病人预后较差。近年来,随着系统性全身治疗及局部治疗手段的不断应用,该类病人的生存期已获得一定改善。目前,以吉西他滨和氟尿嘧啶为基础的化疗方案仍为胰腺癌肝转移病人最主要的治疗方式。靶向治疗方面,奥拉帕利、KRAS抑制剂等针对特定基因突变的药物已展现出一定的治疗潜力。免疫治疗在微卫星高度不稳定(MSI-H)/错配修复功能缺陷(dMMR)亚型病人中疗效显著,但整体疗效仍有限。免疫联合化疗可能成为未来的重要发展方向。局部治疗方面,“转化治疗”模式使部分胰腺癌肝转移病人获得手术机会,显著改善其预后。射频消融、介入治疗和放射治疗等局部治疗手段可提高肝转移病人的局部控制率。当前,胰腺癌肝转移病人的治疗仍面临多项挑战,包括系统性药物治疗手段有限、寡转移定义尚不统一、手术适应证缺乏共识等。未来有待开发新型靶向药物和免疫联合治疗策略,进一步完善多学科全程管理体系,推动胰腺癌肝转移治疗向慢病管理模式转变。

关键词: 胰腺癌, 肝转移, 全身治疗, 局部治疗

Abstract: The liver is the most common metastatic site of pancreatic cancer, and patients with liver metastases have poor prognosis. In recent years, the application of systemic therapies and local treatment modalities has improved survival outcomes in this patient population. Currently, chemotherapy regimens based on gemcitabine and fluorouracil remain the primary therapeutic approach. Targeted therapies, such as PARP inhibitors (e.g., olaparib) and KRAS inhibitors, have shown promising efficacy in patients with specific genetic alterations. While immunotherapy demonstrates significant benefits in MSI-H/dMMR subtypes, its overall effectiveness remains limited, and combining immunotherapy with chemotherapy may represent a future direction for treatment optimization. In terms of local therapy, the “conversion therapy” model has enabled surgical resection in selected patients, significantly improving their prognosis. Additionally, local treatment modalities such as radiofrequency ablation, interventional therapy, and radiotherapy have enhanced local control rates in patients with liver metastases. Despite these advances, challenges remain, including limited treatment options, inconsistent definitions of oligometastasis, and a lack of consensus on surgical indications. Future efforts should focus on developing novel targeted therapies and immunocombination strategies, refining multidisciplinary management approaches, and ultimately transforming pancreatic cancer liver metastases into a chronic manageable condition.

Key words: pancreatic cancer, liver metastasis, systemic therapy, local therapy