局部进展期胰腺癌转化治疗的进展与思考

Progress and reflection of conversion therapy for locally advanced pancreatic cancer

随着胰腺癌非手术治疗效果的逐步提升、胰腺癌解剖学的亚分类日趋精准及外科切除技术的精益求精,越来越多的局部进展期胰腺癌(LAPC)患者获得了转化手术切除的机会,并取得明确的生存获益。尽管当前已开展众多前瞻性临床研究,但在转化治疗的方案策略、疗效评估、手术时机及生存预后方面仍缺乏高级别的循证医学证据,临床上尚缺乏针对此类患者开展转化治疗的具体量化标准和指导原则,手术切除的指征更多依赖于各中心或术者的经验,缺乏一致性。为此,作者梳理了评估LAPC患者转化治疗效果的指标,并对目前探索中的不同模式的转化方案及临床结局进行总结和思考,以期为临床提供更准确的建议和指导。

With the improvement of nonsurgical treatment in pancreatic cancer,the increasing accuracy of subclassification of anatomy,and the continuous refinement of surgical resection techniques,more and more locally advanced pancreatic cancer(LAPC)patients have the opportunity to undergo conversion surgery and achieve survival benefits,which has attracted the attention of scholars in this field.Despite the numerous prospective clinical studies conducted,there is still a lack of high-level evidence-based medical evidence in terms of conversion treatment strategies,efficacy evaluation,surgical timing and survival prognosis,and there are not yet specific quantitative standards and guiding principles for conversion treatment for these patients in clinical practice,and the indications for surgical resection rely more on the experience of each center or surgeon,lacking consistency.Therefore,the indicators for the evaluation of the efficacy of conversion treatment in patients with LAPC were summarized to reflect on the different modes of conversion treatment and clinical outcomes currently being explored,expecting to provide more accurate recommendations and guidance for the clinic.