胆囊癌转化治疗及序贯手术治疗的几个关键问题

Critical issues in conversion therapy and sequential surgical management of gallbladder carcinoma

转化治疗可使初始不可切除肿瘤降期并达到R0切除,使病人获得手术机会,延长生存期。伴随系统治疗进步及综合治疗的不断创新,胆囊癌(GBC)转化治疗逐渐成为探索的热点。制定系统化转化战略时需高度重视GBC的异质性,不能简单遵循指南,应紧跟国际前沿,并对各治疗方案和评价指标的内涵保持清晰的认知,力求实现高度个体化的全程管理。在GBC转化治疗中,免疫治疗3.0模式未来可期,围手术期需高度重视免疫治疗相关不良反应的识别。目前转化人群筛选、转化策略制定、序贯手术时机把握、术后辅助治疗方案选择等诸多问题亟待深入探索,在基础和临床研究尚无法满足临床实战的大背景下,期待各方专家积极总结经验,加强协作,积极开展术前转化治疗和术后辅助治疗多中心临床研究,早日凝聚立足国情的GBC转化治疗共识。

Conversion therapy holds promise in downstaging initially unresectable tumors,achieving R0 resection,affording patients a chance for surgery,and extending survival.With continuous advancements in systemic therapy and comprehensive treatment modalities,conversion therapy for gallbladder cancer(GBC) has emerged as a hot topic of investigation.In formulating a comprehensive conversion strategy for GBC,it is critical to acknowledge the intrinsic heterogeneity observed in GBC and avoid a simplistic adherence to established guidelines.Instead,keeping pace with international advancements and maintaining a profound comprehension of the implications of various treatment approaches and assessment metrics are pivotal for achieving highly individualized strategies.The future holds promising prospects for the application of the Immunotherapy Prototype Mark 3.0 model in GBC conversion therapy.Nevertheless,vigilant surveillance and timely recognition of immunotherapy-related adverse events during the perioperative period assume paramount importance.Several crucial questions are yet to be thoroughly investigated,such as population selection,formulation of conversion strategies,and optimal timing for sequential surgery,as basic and clinical research cannot currently meet the requirements of real-world clinical practice.In light of this context,the author encourages experts from various fields to actively summarize experiences,enhance collaboration,and engage in prospective multicenter studies on preoperative conversion and postoperative adjuvant therapy,with the aim of forming a consensus on GBC conversion therapy with distinct Chinese characteristics.