食管鳞癌围术期综合治疗现状与进展

Current situation and progress of perioperative comprehensive treatment for esophageal squamous cell carcinoma

局部晚期食管鳞癌的治疗策略是以手术为主的综合治疗,如何在围术期合理安排化疗、放疗及免疫治疗是目前学界研究的热点。新辅助治疗方面,已有多项研究证明化疗以及放化疗能够使远期预后获益,但孰优孰劣仍存在争论;新辅助免疫治疗的加入进一步提高了病理完全缓解率,但如何搭配现有新辅助治疗方案以及疗效的精确评估仍有待进一步研究。单纯手术后的辅助治疗能够改善转移淋巴结阳性患者的预后,但新辅助治疗后淋巴结持续阳性的患者辅助治疗并不能带来更多获益,术后辅助免疫治疗也许是常规新辅助治疗(化疗或放化疗)后高危患者提高远期生存的有效治疗模式。

The treatment strategy of locally advanced esophageal squamous cell carcinoma is surgery-based multidisciplinary treatment.How to reasonably arrange chemotherapy,radiotherapy and immunotherapy perioperatively is a hot topic in the academic field.For neoadjuvant therapy,many studies have proved that chemotherapy and chemoradiotherapy could bring long-term survival benefits for patients,yet which is better still remains controversial.The addition of neoadjuvant immunotherapy further improves the pathological complete response rate of patients,whereas how to arrange the available neoadjuvant therapy as well as the accurate evaluation of curative effect still need further research.Postoperative adjuvant therapy after surgery could improve the prognosis of patients with positive metastatic lymph nodes,but for patients with persistent positive lymph nodes after neoadjuvant therapy,postoperative therapy could not bring more benefits.On the other hand,postoperative adjuvant immunotherapy may be an effective treatment strategy to improve the long-term survival of high-risk patients after conventional neoadjuvant therapy(chemotherapy or chemoradiotherapy).