Ⅲa(N2)期非小细胞肺癌治疗进展

Progress in the treatment of stage Ⅲa(N2) non-small cell lung cancer

Ⅲa(N2)期NSCLC患者存在明显的生存差异,治疗方式的选择存在争论,是需要多学科综合治疗的异质性群体。手术从最重要的治疗方式演变为主要治疗方式之一,未来的地位可能进一步弱化;放疗随着技术层面的进步,将扮演更加重要的角色;化疗与免疫治疗的结合应得到更多的重视,需进一步阐明机理;靶向治疗与免疫检查点抑制剂在该类型患者中的应用值得进一步的研究。肿瘤细胞和宿主免疫系统在免疫微环境中通过相互作用促进免疫逃避并导致肿瘤的复发及转移,目前通过PD途径抗肿瘤等免疫治疗产品已经应用于临床并取得一定成效,该治疗原理主要依赖于浸润到肿瘤和肿瘤微环境中的效应T细胞的功能。根据肿瘤细胞周围免疫细胞(主要为T细胞等)浸润情况,相关研究确立了新型免疫表型分类,为患者治疗和预后提供思路及方向,免疫微环境值得进一步探讨。免疫治疗成为继手术、放化疗等传统治疗方法后一种新的重要治疗手段,为抗肿瘤治疗带来了巨大希望。

There is a significant difference in survival between IIIa(N2)stage NSCLC,and the choice of treatment methods is controversial.It is a heterogeneous group that requires multidisciplinary treatment.Surgery has evolved from the most important treatment to one of the main treatments.The future status may be further weakened;radiotherapy will play a more important role as the technical level progresses;the combination of chemotherapy and immunotherapy should receive more attention.The mechanism needs to be further elucidated;the application of targeted therapy and immunological checkpoint inhibitors in this type of patient deserves further study.Interaction between tumor cells and the host immune system in tumor immune microenvironment,through mutual role in the immune microenvironment immune escape and cause the recurrence and metastasis of tumors,the current through PD way antitumor immune therapy such as products have been applied to clinical and obtained certain achievements,the treatment principle mainly relies on the infiltrating into the tumors and the tumor microenvironment effect the function of T cells.According to the infiltration of immune cells around tumor cells(mainly T cells,etc.),relevant studies have established the classification of new immunophenotypes,providing ideas and directions for the treatment and prognosis of patients,and the immune microenvironment is worth further discussion.Immunotherapy has become a new important treatment method after the traditional treatment methods such as surgery,radiotherapy and chemotherapy.