胆囊癌治疗的新进展

New advances in the treatment of gallbladder cancer

外科手术仍为治愈早期胆囊癌的首选治疗方式,而手术策略则依据原发肿瘤的解剖位置、准确的术前分期、严格把握手术适应证、选择合适手术方式以达到最佳外科疗效。然而,大多数患者在初次就诊时已处于局部进展期或发生转移,即使接受胆囊癌根治术,其术后复发率和5年总生存率仍不理想,因此,迫切需要更多治疗策略参与胆囊癌患者的全程治疗管理,如新辅助治疗、术后辅助治疗以及局部进展期和转移胆囊癌的一线、二线治疗。近年来,分子靶向药物和免疫疗法的应用,为胆囊癌治疗带来更大的希望和更广阔的前景,但其对改善患者预后仍缺乏足够的循证医学证据,尚需进一步研究结果解决诸多问题。笔者结合国内外胆囊癌研究最新进展,系统梳理胆囊癌治疗动态,期望能为广大读者提供一幅宏观系统但又不失必要细节的治疗简图,怀抛砖引玉之心,求按图索骥之功。

Surgery is still the first choice for the curation of early gallbladder cancr,and the surgical strategy is selected based oanatomic position of primary tumor,accurate preoperative stage,and strict indication assessment in order to achieve the optimal curative effect.However,most patients are in advanced stage or with distant metastasis at the first diagnosis,and the recurrence rate and 5-year survival rate are not satisfied even if they receive curative resection.Subsequently,it is urgent for the employment of more treatment strategies in the process management of gallbladder cancer patients,such as neoadjuvant therapy,postoperative therapy and first-line or second-line treatment of local advanced and metastatic patients.In recent years,application of molecular targeted agents and immunotherapy have brought greater hope and laid a vaster prospect for treatment of gallbladder cancer.However,there is still lack of evidence-based medicine data on the prognostic results,and further researches are needed.By integrating the domestic and abroad new research achievements,the authors systematically summarize the current status and future trend on the management of gallbladder cancer,and hope to provide a macroscopic and systemic treatment chart,including necessary details.