MDT模式下胰腺癌治疗理念更新与转变.docVIP

MDT模式下胰腺癌治疗理念更新与转变 杨尹默 北京大学第一医院外科 X 关注成功！ 加关注后您将方便地在 我的关注中得到本文献的被引频次变化的通知！ 新浪微博 腾讯微博 人人网 开心网 豆瓣网 网易微博 摘????要： 胰腺癌在所有消化道肿瘤中预后最差, 治疗极具挑战性。胰腺癌的治疗模式正在由“surgery first”过渡到多学科综合治疗协作组 (MDT) 模式。提倡对“可能切除”的胰腺癌先给予术前治疗, 以提高手术R0切除率, 改善病人预后。不同术者、不同中心对“可能切除”胰腺癌的定义及判断标准存在差异, 影响了临床研究的可比性, 故尚需多中心前瞻性研究进一步验证术前治疗改善病人预后的作用。“潜在可治愈”的胰腺癌包括“可切除”及“可能切除”的病人, 该定义体现出审视问题的视角及高度正从外科学向肿瘤学的转变。 关键词： 胰腺癌; 分类; 定义; 新辅助治疗; 多学科综合治疗协作组; 作者简介：杨尹默 E-mail:yangyinmo@263.net 收稿日期：2017-05-23 The mode of MDT gives rise to the concept modification about surgical treatments of pancreatic carcinoma YANG Yin-mo Department of Surgery, Peking University First Hospital; Abstract： Pancreatic carcinoma has the poorest prognosis in all the digestive cancers, and the management is still challenging. Nowadays the treatment strategy of pancreatic carcinoma has been changed from“surgery first”into the mode of multi-disciplinary team (MDT) . Preoperative therapy is recommended for patients with borderline resectable pancreatic carcinoma so as to increase the R0 rates and improve the prognosis. However, there continues to be a blurring about the definitions of borderline resectability, which are all too often institution and operator dependent.Randomized clinical trials are needed to further evaluate the clinical outcome of preoperative therapy. Both the resectable and borderline resectable tumors could be defined as potentially curable pancreatic cancer. The definition change reflects the conversion from the mode of morphology and surgery to biology and oncology. Keyword： pancreatic carcinoma; classification; definitio; neoadjurant therapy; multi-disciplinary team; Received： 2017-05-23 胰腺癌发病率在全球范围内呈上升趋势, 病死率在发达国家恶性肿瘤中位列第4位, 预测美国未来10年内其病死率将跃居第2位[1]。近30年来, 胰腺癌手术切除率及安全性有了极大提高, 围手术期病死率及严重并发症发生率显著下降, 但病人预后仍无明显改善。美国Memorial SloanKettering Cancer Center回顾性分析过去30年间行手术切除的1147例胰腺导管腺癌病人的资料, 以每10年为一个时间段统计, 发现30年来胰腺癌病人的预后无显著改善[2];Wisconsin大学医院回顾过去20年间216例行胰十二指肠切除术的胰头癌病人的临床资料, 仍以每10年为一个时间段进行预后比较, 两组差异亦无统计学意义[3]。我国虽然缺乏来自大中心的大