局部进展期直肠癌新辅助治疗研究进展

Research progress in neoadjuvant therapy for locally advanced rectal cancer

目的分析各新辅助治疗策略的优劣,为临床诊疗提供参考,并为进一步研究探索提供方向。方法检索并查阅近年来国内外医学数据库(PubMed、EMBASE、Cochrane Library、维普数据库、中国知网、万方数据库等),对局部进展期直肠癌新辅助治疗的相关文献进行综述。结果新辅助治疗可以降低肿瘤分期、提高保肛率、降低局部复发率,但并未显著降低远处转移率和侧方淋巴结转移率,也未改善长期生存。越来越多的优化新辅助方案应运而生。分子靶向药物和免疫治疗正被尝试应用于临床,结合新兴生物学标志物的研究,以提高局部进展期直肠癌患者的疗效,并减少治疗相关副作用,改善患者的生存获益。结论新辅助治疗是局部进展期直肠癌标准治疗策略,对新辅助治疗模式的探索有望进一步提高治疗效果、减轻毒副反应,并改善生存预后。通过结合肿瘤分子生物学指标识别和筛选获益人群,有望成为未来研究的重要方向。

Objective To analyze the advantages and disadvantages of various neoadjuvant therapy,provide reference for clinical diagnosis and treatment,and provide direction for further research and exploration.Method The recent domestic and international medical databases(PubMed,EMBASE,Cochrane Library,VIP database,CNKI,WanFang database,etc.)were searched and the relevant literature on neoadjuvant therapy for locally advanced rectal cancer(LARC)were reviewed.Results Neoadjuvant therapy could decrease tumor staging,increase anal reserving rate,and reduce local recurrence rate,but it does not significantly reduce the rates of distant metastasis and lateral lymph node metastasis,nor does it improve long-term survival.More and more optimization neoadjuvant therapy had emerged.Molecular targeted drugs and immunotherapy were being attempted for clinical using,combined with research on emerging biomarkers,to improve the therapeutic efficacy of LARC patients,reduce treatment related side effects,and improve patient survival benefits.Conclusions Neoadjuvant therapy is the standard treatment strategy for LARC,and the exploration of neoadjuvant treatment models is expected to further improve treatment effectiveness,reduce toxic side effects,and improve survival prognosis.By combining tumor molecular biology indicators to identify and screen beneficiaries,it is expected to become an important direction for future research.