食管癌新辅助治疗的研究进展

Research Progress on Neoadjuvant Therapy for Esophageal Cancer

摘要: 食管癌是全球常见的恶性肿瘤之一，国家癌症中心统计显示2022年中国食管癌新发病例约22.4万例，排名第七位，死亡约18.75万例，排名第五位，我国食管癌新发病例和死亡病例约占全球的一半。食管癌发病时会导致患者胸骨疼痛、进食出现吞咽困难与异物感等症状，具有发病前期隐匿、症状特异性差、病情进展快以及淋巴结转移风险高的特点。大多数患者确诊时已处于中晚期，单纯手术治疗效果欠佳，5年生存率仅20%~30%。随着现代综合医学的发展，肿瘤治疗方案也不断丰富完善，新辅助治疗逐渐成为中晚期食管癌患者一线治疗方案中不可或缺的重要组成部分。新辅助治疗作为综合治疗的重要环节，可使局部晚期肿瘤降期，增加根治性切除的机会，同时杀灭体内潜在的微转移病灶，提高患者的长期生存率。目前临床上主要采用新辅助放疗、新辅助化疗、新辅助放化疗以及新辅助免疫治疗联合化疗/放化疗等方案，在临床中的价值得到广泛认可，但不同方案的选择在不同患者治疗过程中以及疗效存在一定争议。本文针对食管癌新辅助治疗的现状展开详细阐述，为临床治疗提供参考。

Abstract: Esophageal cancer is one of the most common malignant tumors globally. According to the statistics of the National Cancer Center, in 2022, there were approximately 224,000 newly diagnosed cases of esophageal cancer in China, ranking seventh, and about 187,500 deaths, ranking fifth. The newly diagnosed cases and deaths of esophageal cancer in China account for nearly half of the global total. When esophageal cancer occurs, patients may experience symptoms such as sternal pain, dysphagia, and a foreign-body sensation during eating. It is characterized by insidious onset in the early stage, poor symptom specificity, rapid disease progression, and a high risk of lymph node metastasis. Most patients are diagnosed at the middle or advanced stage, and the effect of simple surgical treatment is not satisfactory, with a 5-year survival rate of only 20%~30%. With the development of modern comprehensive medicine, tumor treatment regimens have been continuously enriched and improved. Neoadjuvant therapy has gradually become an indispensable and important part of the first-line treatment regimens for patients with middle- and advanced-stage esophageal cancer. As a crucial part of comprehensive treatment, neoadjuvant therapy can downstage locally advanced tumors, increase the chance of radical resection, and at the same time, eliminate potential micrometastatic lesions in the body, thereby improving the long-term survival rate of patients. Currently, clinically, neoadjuvant radiotherapy, neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy, and neoadjuvant immunotherapy combined with chemotherapy/chemoradiotherapy are mainly adopted. The clinical value of these regimens has been widely recognized, but there are still some controversies regarding the selection of different regimens during the treatment of different patients and their curative effects. This paper elaborates in detail on the current status of neoadjuvant therapy for esophageal cancer to provide a reference for clinical treatment.