新辅助化疗在胰腺癌中的临床应用与进展

Clinical Application and Progress of Neoadjuvant Chemotherapy in Pancreatic Cancer

摘要: 目前胰腺癌的根治性手段仍是手术切除，但大部分确诊患者并不适合手术治疗。多项大型多中心试验已初步证实新辅助化疗在胰腺癌中具有缩小肿瘤病灶、降低肿瘤分期、提高R0切除率，以及减少神经和淋巴管侵犯、减少微转移灶，进而降低患者的术后并发症、改善预后的作用。但在不同分期的胰腺癌化疗中，其有效性仍存在争议，需要更多的循证医学依据。至今，新辅助化疗并无标准方案，目前临床上大多采用FOLFIRINOX/改良FOLFIRINOX和AG方案，并已取得不错的疗效。此外，正在进行的相关试验也在进一步探索新型新辅助化疗方案。影像学和血清标志物可反映患者化疗的疗效，评价治疗缓解程度，但其准确性仍具有争议，需探索更多的可靠标准。

Abstract: Currently, surgical resection remains the only curative treatment for pancreatic cancer; however, the majority of diagnosed patients are not candidates for surgery. Several large, multicenter trials have preliminarily confirmed that neoadjuvant chemotherapy can reduce tumor size, lower tumor staging, improve the R0 resection rate, and decrease nerve and lymphatic invasion, as well as minimize micro-metastases. This, in turn, can reduce postoperative complications and improve patient prognosis. However, the efficacy of chemotherapy at different stages of pancreatic cancer remains controversial, and more evidence from clinical trials is needed. To date, there is no standard neoadjuvant chemotherapy regimen, with most clinicians using FOLFIRINOX, modified FOLFIRINOX, or the AG regimen, all of which have shown promising results. Furthermore, ongoing trials are continuing to explore novel neoadjuvant chemotherapy options. Imaging techniques and serum biomarkers can reflect the effectiveness of chemotherapy and assess treatment response, but their accuracy remains debated, and more reliable standards need to be established.