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在dMMR直肠癌中免疫疗法诱导的完整反应 - 一个外科手术困境?

Panagiotis Loufopoulos¹, Konstantinos Perivoliotis¹, Danai Chatziathanasiou²

¹Department of Colorectal Surgery, Royal Marsden Hospital, NHS Foundation Trust, London SW3 6JJ, UK.

|October 16, 2025

概括

对于缺少不匹配修复的直肠癌,免疫治疗的完整反应提供了两个途径:手术或通过观察和等待保存器官. 两种方法的存活率相似,但观察和等待可以避免手术风险并保持器官功能.

科学领域:

在瘤学瘤学.
胃肠病学胃肠病学
免疫治疗是一种免疫疗法.

背景情况:

缺陷不匹配修复 (dMMR) 的直肠癌很罕见 (10%),但对免疫检查点抑制剂的反应很强,经常达到完全缓解.
这种高响应率带来了临床挑战:标准手术与观察和等待方法的器官保存相比.

研究的目的:

审查有关dMMR直肠癌患者实现完整反应的反应评估,决策,瘤结果和生活质量的当前文献.
为了比较手术切除与观察和等待管理策略.

主要方法:

临床试验和回顾性研究的综合文献审查,直到2025年.
专注于反应评估,决策框架,瘤学结果和生活质量.

主要成果:

多斯塔利马布实现了100%的临床完整反应;手术产生了68-92%的病理完整反应.
伪进展和伪残留复杂的反应评估,需要专门的评估.
手术和观察和等待方法都显示在2-3年内100%的无病生存率.
观察和等待可以保护器官的完整性,避免结肠直肠 (15.4%) 和并发症 (19.3%).
手术提供了最终的组织确认,并减少了关于复发的焦虑.

结论:

在手术和dMMR直肠癌的观察和等待之间做出选择,需要平衡瘤结果与生活质量.
个性化决策至关重要,考虑到患者的偏好,功能维护和机构能力.

关键词:

一个完整的响应反应.dMMR 是一个MMR.新辅助免疫疗法新辅助免疫疗法器官的保存器官的保存这是直肠癌.外科手术的困境在外科手术的困境观看和等待的观看和等待

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Tumor Immunotherapy

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