局部晚期宫颈癌新辅助化疗后同步放化疗与 免疫治疗的序贯策略：现状与挑战

Sequential Strategies of Neoadjuvant Chemotherapy Followed by Concurrent Radiotherapy and Immunotherapy for Locally Advanced Cervical Cancer: Current Status and Challenges

摘要: 本文综述了局部晚期宫颈癌(LACC)在应用新辅助化疗(NACT)后，采用同步放化疗(CCRT)与免疫检查点抑制剂序贯治疗策略的现状与挑战。文章分析了NACT在肿瘤降期中的价值及其疗效异质性，强调了基于生物标志物进行患者分层的重要性。同时，深入阐述了CCRT与免疫治疗协同作用的生物学机制，包括其对肿瘤免疫微环境的重塑及可能产生的“远隔效应”，并重点讨论了免疫治疗介入的最佳时机这一关键临床决策点。当前临床实践面临NACT无效患者挽救策略缺乏、治疗毒性叠加以及淋巴结转移等高风险人群管理等多重挑战。展望未来，综述指出整合多组学动态监测与人工智能预测模型，以阐明联合治疗机制并实现真正的个体化精准治疗，是改善LACC患者预后的核心方向。

Abstract: This article reviews the current status and challenges of sequential treatment strategies involving concurrent chemoradiotherapy (CCRT) and immune checkpoint inhibitors after neoadjuvant chemotherapy (NACT) in locally advanced cervical cancer (LACC). It analyzes the value of neoadjuvant chemotherapy in tumor downstaging and its heterogeneous efficacy, emphasizing the importance of patient stratification based on biomarkers. Meanwhile, it elaborates on the biological mechanisms of the synergistic effect between concurrent chemoradiotherapy and immunotherapy, including the remodeling of the tumor immune microenvironment and the possible “abscopal effect”, and focuses on discussing the optimal timing of immune therapy intervention as a key clinical decision point. Current clinical practice faces multiple challenges, including the lack of salvage strategies for patients with ineffective neoadjuvant chemotherapy, the superimposition of treatment toxicity, and the management of high-risk groups with lymph node metastasis. Looking to the future, the review points out that integrating multi-omics dynamic monitoring and artificial intelligence prediction models to clarify the mechanism of combined treatment and achieve true individualized precision treatment is the core direction for improving the prognosis of patients with locally advanced cervical cancer.