Berger Julia M, Preusser Matthias, Berghoff Anna S, Bergen Elisabeth S
Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
Cancer Treat Rev. 2023 Oct 24;121:102646. doi: 10.1016/j.ctrv.2023.102646.
Ascites formation is a common complication of cancer with a significant symptomatic burden for patients. Malignant ascites (MA) is defined by the presence of tumor cells within the ascitic fluid. It does not only cause substantial morbidity, but is also associated with impaired survival. Considering the frequent occurrence of MA, it still represents a clinical challenge for physicians with limited therapy options, mainly comprising of the treatment of the primary tumor and effusion drainage. Particularly the lack of pathophysiological insight limits the development of effective, causative therapies. Causes of MA development such as lymphatic vessel obstruction and the effects of tumor secreted vascular endothelial growth factor (VEGF) have been known for decades. Novel research suggests that the intraperitoneal immune system may also induce and maintain MA accumulation. In this review, we assess current knowledge on the pathophysiology of MA and summarize available evidence of treatment approaches. Also, factors contributing to ascites formation without proof of tumor cells in the peritoneal cavity, defined as paramalignant ascites, with potential treatment strategies are discussed. We further focus on novel findings in the pathophysiology of MA that might lead to treatment improvement in the near future and discussed relevant knowledge gaps in this field.
腹水形成是癌症常见的并发症，给患者带来明显的症状负担。恶性腹水（MA）由腹水中存在肿瘤细胞定义。它不仅会导致严重的发病率，还与生存受损有关。考虑到MA的频繁发生，它仍然是临床医生面临的一个挑战，治疗选择有限，主要包括原发性肿瘤治疗和积液引流。特别是缺乏病理生理学认识限制了有效、病因性疗法的发展。几十年来，人们已经知道MA发生的原因，如淋巴管阻塞和肿瘤分泌的血管内皮生长因子（VEGF）的作用。新的研究表明，腹膜免疫系统也可能诱导并维持MA的积聚。在这篇综述中，我们评估了关于MA病理生理学的当前知识，并总结了现有治疗方法的证据。此外，还讨论了在腹腔内无肿瘤细胞证据的情况下导致腹水形成的因素，即副恶性腹水，以及潜在的治疗策略。我们进一步关注MA病理生理学的新发现，这些发现可能在不久的将来改善治疗，并讨论了该领域相关的知识空白。
