超声引导下热消融联合程序性死亡蛋白-1抑制剂治疗结直肠癌肝转移的研究进展

Research progress of ultrasound-guided thermal ablation combined with programmed death-1 inhibitor in the treatment of colorectal cancer liver metastases

结直肠癌(CRC)患者全病程中超半数有肝转移,转移灶多数无法获得根治性切除且易复发,是结直肠癌患者预后差的主要因素。热消融治疗已成为结直肠癌肝转移无法手术患者的替代治疗,不仅可消除局部病灶,亦可增强患者的抗肿瘤免疫反应,但长期而言,不足以预防肿瘤进展。超声因具有实时显像、引导准确、简易便捷等颇多优势,是热消融治疗惯用的引导方式。如今,癌症的免疫疗法新兴崛起,诸如免疫检查点抑制剂(ICIs)等在多种癌症治疗中不断取得突破性进展。许多基础研究发现,热消融联合免疫疗法可以激活患者的免疫抑制状态,为进一步的临床应用提供了充分的理论依据。本文主要阐述结直肠癌肝转移(CRLM)的超声引导下热消融治疗、程序性死亡蛋白-1(PD-1)抑制剂的免疫治疗、以及两者联合应用的研究进展。

More than half of colorectal cancer(CRC)patients have liver metastases in the whole course of the disease.Most of the metastases cannot be radically removed and are prone to recurrence,which is the main factor for the poor prognosis of colorectal cancer patients.Thermal ablation therapy has become an alternative treatment for patients with inoperable colorectal cancer liver metastases.It can not only eliminate local lesions,but also enhance the patients′anti-tumor immune response,but in the long run,it is not enough to prevent tumor progression.Ultrasound has many advantages such as real-time imaging,accurate guidance,simplicity and convenience,etc.,and is the usual guidance method for thermal ablation therapy.Today,immunotherapy for cancer is emerging,and breakthroughs have been made in the treatment of various cancers,such as immune checkpoint inhibitors(ICIs).Many basic studies have found that thermal ablation combined with immunotherapy can activate the immunosuppressive state of patients,providing a sufficient theoretical basis for further clinical applications.This article mainly describes the research progress of ultrasound-guided thermal ablation therapy of colorectal cancer liver metastases(CRLM),immunotherapy of PD-1 inhibitors,and their combined application.