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胃癌及肝转移的免疫疗法:是时候告别了吗?

Immunotherapy for gastric cancer and liver metastasis: Is it time to bid farewell.

作者信息

Dehal Ahmed

机构信息

Department of Clinical Sciences, Kaiser Permanente School of Medicine, Panorama, CA 91402, United States.

出版信息

World J Gastrointest Surg. 2024 Aug 27;16(8):2365-2368. doi: 10.4240/wjgs.v16.i8.2365.

Abstract

Patients with metastatic gastric cancer have a grim prognosis. Palliative chemotherapy offers a limited survival improvement, but recent advancements in immunotherapy have sparked hope. However, the effectiveness of immunotherapy in patients with liver metastases remains debated. This article reviews a recent study by Liu and evaluates conflicting evidence on the impact of liver metastases on response to immunotherapy in metastatic gastric cancer. While some studies suggest no significant difference in treatment response based on liver involvement, others report varied response rates. The present study, a retrospective analysis of 48 patients by Liu , examines this issue and concludes that immunotherapy is less effective in patients with liver metastases. Despite methodological limitations and a small sample size, the study contributes to the ongoing discourse. The nuanced response to immunotherapy in certain patients underscores the importance of understanding the tumor microenvironment, immune cell infiltration, and the expression of immune checkpoints. Rather than dismissing immunotherapy for patients with gastric cancer and liver metastases, a shift towards personalized treatment strategies and a more profound understanding of tumor-specific biomarkers is essential. By unraveling the molecular intricacies of individual cases, clinicians may tailor more effective and customized treatments, offering a glimmer of hope for this challenging patient group.

摘要

转移性胃癌患者的预后严峻。姑息化疗只能有限地延长生存期,但免疫疗法的最新进展带来了希望。然而,免疫疗法对肝转移患者的有效性仍存在争议。本文回顾了Liu等人最近的一项研究,并评估了关于肝转移对转移性胃癌免疫治疗反应影响的相互矛盾的证据。虽然一些研究表明,根据肝脏受累情况,治疗反应没有显著差异,但其他研究报告的反应率各不相同。Liu等人对48例患者进行的这项回顾性研究探讨了这个问题,并得出结论:免疫疗法对肝转移患者的效果较差。尽管存在方法学上的局限性和样本量较小的问题,但该研究为正在进行的讨论做出了贡献。某些患者对免疫疗法的细微反应凸显了了解肿瘤微环境、免疫细胞浸润和免疫检查点表达的重要性。对于患有胃癌和肝转移的患者,不应摒弃免疫疗法,转向个性化治疗策略并更深入地了解肿瘤特异性生物标志物至关重要。通过揭示个体病例的分子复杂性,临床医生可以制定更有效、更个性化的治疗方案,为这一具有挑战性的患者群体带来一线希望。

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Consideration on immunotherapy of liver metastases of malignant tumors.恶性肿瘤肝转移的免疫治疗思考
World J Gastrointest Surg. 2024 Aug 27;16(8):2374-2381. doi: 10.4240/wjgs.v16.i8.2374.

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