IIB期子宫颈癌多模态治疗进展：从传统范式到精准医学

Advances in Multimodal Treatment for Stage IIB Cervical Cancer: Transitioning from Traditional Methods to Precision Medicine

摘要: IIB期子宫颈癌因存在宫旁浸润其治疗面临独特挑战。本文综述当前多模式治疗证据，以及向精准医学策略转变的趋势。通过评估指南推荐、随机试验、荟萃分析及近期临床研究，比较了标准治疗方案——同步放化疗，与在某些地区更受青睐的新辅助化疗联合根治性子宫切除术策略的疗效与地位。尽管两种治疗模式的总生存期似无明显差异，但其短期与长期毒性谱存在不同。精准肿瘤学的最新进展进一步拓展了治疗选择。血管内皮生长因子抑制剂贝伐珠单抗、抗体药物偶联物及免疫检查点抑制剂等药物，改善了复发或转移性患者的预后，并显示出与同步放化疗方案结合的日益增长的潜力。然而，诸多挑战依然存在，包括针对初治IIB期患者的证据有限、生物标志物异质性、毒性管理，以及治疗成本与可及性方面的显著差异。总之，将靶向及免疫治疗药物纳入多模式治疗方案，或能改善部分IIB期宫颈癌患者的预后。当前仍需高质量的多中心临床试验，以及具有成本效益、由生物标志物驱动的治疗策略，以建立最优的个体化治疗框架。

Abstract: Stage IIB cervical cancer presents unique treatment challenges due to its presence of parametrial invasion. This review summarizes current evidence for multimodal therapy and the trend toward precision medicine strategies. By evaluating guideline recommendations, randomized trials, meta-analyses, and recent clinical studies, we compared the efficacy and status of standard concurrent chemoradiotherapy with the increasingly favored neoadjuvant chemotherapy plus radical hysterectomy strategy in certain regions. Although overall survival appears comparable between the two treatment modalities, their short- and long-term toxicity profiles differ. Recent advances in precision oncology have further expanded therapeutic options. Drugs such as the vascular endothelial growth factor inhibitor bevacizumab, antibody-drug conjugates, and immune checkpoint inhibitors have improved outcomes for recurrent or metastatic patients and demonstrate growing potential when combined with concurrent chemoradiotherapy. Nevertheless, significant challenges persist, including limited evidence for treatment-naive stage IIB patients, biomarker heterogeneity, toxicity management, and substantial disparities in treatment costs and accessibility. In summary, incorporating targeted and immunotherapy agents into multimodal treatment regimens may improve outcomes for selected stage IIB cervical cancer patients. High-quality multicenter clinical trials and cost-effective, biomarker-driven therapeutic strategies are still needed to establish optimal personalized treatment frameworks.