食管癌围手术期免疫治疗的研究进展与未来展望

刘 雯莉1, 马 金华2
1、青海大学
2、青海大学附属医院肿瘤内科三病区

摘要


食管癌是全球高发恶性肿瘤，在中国尤为突出。传统手术、放化疗对早期患者有效，但中晚期患者疗效有
限且易复发。近年来，免疫检查点抑制剂（ICIs）显著改善了食管癌预后，尤其在围手术期展现出潜力：新辅助免
疫治疗通过术前激活抗肿瘤免疫反应，缩小肿瘤并增强免疫记忆，显著提高病理完全缓解率和生存率；术后辅助免
疫治疗则清除残留病灶，降低复发风险，延长无病生存期。联合治疗策略（如免疫+放化疗、靶向治疗）通过协同
增效成为研究热点，进一步提升了抗肿瘤效果。然而，免疫治疗仍面临挑战，包括免疫相关不良事件（irAEs）管理、
耐药机制及精准生物标志物缺乏。未来需优化治疗时机、剂量和疗程，开发新型高效药物（如靶向T细胞衰竭通路
制剂），并探索PD-L1、TMB、ctDNA等标志物的动态监测与多组学整合应用，以实现疗效预测个体化。围手术期
免疫治疗的革新为食管癌提供了新希望，但其临床转化需兼顾安全性、经济可及性及多学科协作，最终推动患者长
期生存获益的全面提升。

关键词


食管癌；免疫疗法；免疫检查点抑制剂；ICI；生物标志物；联合治疗策略

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参考


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