Jiang Chuang, Zhang Zhi-Hong, Li Jia-Xin
Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, and State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Department of General Surgery, Dafang County People's Hospital, Bijie 551600, Guizhou Province, China.
World J Gastrointest Surg. 2024 Aug 27;16(8):2374-2381. doi: 10.4240/wjgs.v16.i8.2374.
In this editorial, we comment on the article "Analysis of the impact of immunotherapy efficacy and safety in patients with gastric cancer and liver metastasis" by Liu that was published in the recent issue of the . It has prompted us to think and summarize some thoughts on immunotherapy for malignant tumor liver metastasis. Immunotherapy plays a crucial role in the treatment of malignant tumors; however, the presence of liver metastases in advanced tumors may impact its efficacy. Although patients with liver metastases can still benefit from immunotherapy, multiple clinical studies have indicated that, compared to other sites of metastasis, liver metastases may diminish the effectiveness of immunotherapy. The efficacy of immune checkpoint inhibitors in patients with liver metastases often fails to reach the ideal level, primarily due to the liver metastases exploiting the host's peripheral immune tolerance mechanisms to promote systemic CD8(+) T cell exhaustion, resulting in a systemic immune-tolerant environment. This article aims to summarize the reasons for the decreased efficacy of immunotherapy following liver metastasis in various malignant tumors and propose potential clinical strategies for management.
在这篇社论中，我们对刘发表在最近一期《》上的文章《胃癌肝转移患者免疫治疗疗效与安全性的影响分析》进行评论。它促使我们思考并总结一些关于恶性肿瘤肝转移免疫治疗的想法。免疫治疗在恶性肿瘤治疗中起着关键作用；然而，晚期肿瘤出现肝转移可能会影响其疗效。虽然肝转移患者仍可从免疫治疗中获益，但多项临床研究表明，与其他转移部位相比，肝转移可能会降低免疫治疗的效果。免疫检查点抑制剂在肝转移患者中的疗效往往未能达到理想水平，主要原因是肝转移利用宿主的外周免疫耐受机制促进全身CD8(+) T细胞耗竭，从而导致全身免疫耐受环境。本文旨在总结各种恶性肿瘤肝转移后免疫治疗疗效降低的原因，并提出潜在的临床管理策略。
