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中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺疾病专业委员会. 中国胰腺癌新辅助治疗指南(2020版)[J]. 协和医学杂志, 2020, 11(5): 547-558. doi: 10.3969/j.issn.1674-9081.2020.05.010
引用本文: 中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺疾病专业委员会. 中国胰腺癌新辅助治疗指南(2020版)[J]. 协和医学杂志, 2020, 11(5): 547-558. doi: 10.3969/j.issn.1674-9081.2020.05.010
Study Group of Pancreatic Surgery in China Society of Surgery of Chinese Medical Association, Pancreatic Disease Committee of China Research Hospital Association. The Guideline for Neoadjuvant Therapy of Pancreatic Cancer in China (2020 Edition)[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(5): 547-558. doi: 10.3969/j.issn.1674-9081.2020.05.010
Citation: Study Group of Pancreatic Surgery in China Society of Surgery of Chinese Medical Association, Pancreatic Disease Committee of China Research Hospital Association. The Guideline for Neoadjuvant Therapy of Pancreatic Cancer in China (2020 Edition)[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(5): 547-558. doi: 10.3969/j.issn.1674-9081.2020.05.010

中国胰腺癌新辅助治疗指南(2020版)

doi: 10.3969/j.issn.1674-9081.2020.05.010
详细信息
    通讯作者:

    赵玉沛  电话:010-69155810,E-mail:zhao8028@263.net

  • 中图分类号: R735.9

The Guideline for Neoadjuvant Therapy of Pancreatic Cancer in China (2020 Edition)

More Information
    Corresponding author: ZHAO Yu-pei  Tel:86-10-69155810, E-mail: zhao8028@263.net
  • 摘要: 为提高我国胰腺癌的总体治疗水平,中华医学会外科学分会胰腺外科学组、中国研究型医院学会胰腺疾病专业委员会组织相关专家制定了本指南。本指南基于推荐分级的评价、制定与评估(Grading of Recommendations Assessment, Development and Evaluation, GRADE)系统,针对胰腺癌新辅助治疗的应用指征、方案选择、疗效评估及其相关病理学诊断、手术策略等热点问题展开讨论,对现有临床研究的证据等级量化评估并提出推荐意见,以指导并促进胰腺癌新辅助治疗的临床实践。本指南强调多学科综合治疗协作组的重要地位,体现出胰腺癌治疗理念的转变。新辅助治疗能够有效延长部分胰腺癌患者的生存期,但仍需开展高质量临床研究,以进一步提升证据等级,完善临床实践方案,改善患者预后。
    利益冲突:无
  • 表  1  证据等级标准

    证据等级及说明 削弱证据强度的因素 提高证据强度的因素
    高:真实效应值非常接近估计值
    中:真实效应值接近估计值
    低:真实效应值可能与估计值存在差异
    极低:真实效应值很可能与估计值存在差异
    (1)研究自身的缺陷,如低质量的随机对照试验,存在偏倚的可能性较大
    (2)结果的不一致性
    (3)证据的间接性
    (4)结果的不确定性
    (5)研究很可能存在报告偏倚
    (1)样本量非常大
    (2)有明显的剂量-反应关系
    (3)所有可能的偏倚均倾向于削弱干预组的治疗效果
    下载: 导出CSV

    表  2  胰腺癌可切除性评估标准

    状态 动脉 静脉
    可切除 肿瘤未触及CA、SMA或CHA 肿瘤与SMV存在间隙,或与PV的触及范围虽≤180°,但静脉轮廓规则
    临界可切除 胰头和/或钩突部:(1)肿瘤触及CHA,但未累及CA或肝动脉起始部,允许安全切除和重建;(2)肿瘤触及SMA≤180°;(3)肿瘤触及变异动脉如副肝右动脉、替代肝右动脉、替代CHA及其他替代或副动脉起始部等胰体和/或尾部:(1)肿瘤触及CA≤180°;(2)肿瘤触及CA>180°但未侵犯主动脉,且胃十二指肠动脉完整 (1)肿瘤触及SMV或PV的范围>180°;或与SMV、PV的触及范围虽≤180°,但静脉轮廓不规则或合并静脉内血栓形成;受累部位的近端和远端血管正常,完整切除后可安全重建;(2)肿瘤触及IVC
    局部进展 胰头和/或钩突部:肿瘤触及SMA或CA>180°胰体和/或尾部:(1)肿瘤触及SMA或CA>180°;(2)肿瘤触及CA和主动脉 胰头和/或钩突部:因为肿瘤侵犯或血管阻塞导致SMV、PV无法重建(也可因为瘤栓或血栓导致)
    CA:腹腔干;SMA:肠系膜上动脉;CHA:肝总动脉;SMV:肠系膜上静脉;PV:门静脉;IVC:下腔静脉
    下载: 导出CSV

    表  3  胰腺癌常用新辅助治疗方案

    方案 体能状态 具体方案 可调整方案
    FOLFIRINOX 较好 奥沙利铂85 mg/m2静脉滴注2 h,第1天;伊立替康180 mg/m2静脉滴注30~90 min,第1天;亚叶酸钙400 mg/m2静脉滴注2 h,第1天;氟尿嘧啶400 mg/m2静脉滴注,第1天,然后2400 mg/m2静脉滴注46 h;每2周重复1次 奥沙利铂68 mg/m2静脉滴注2 h,第1天;伊立替康135 mg/m2静脉滴注30~90 min,第1天;亚叶酸钙400 mg/m2静脉滴注2 h,第1天;氟尿嘧啶2400 mg/m2静脉滴注46 h;每2周重复1次
    吉西他滨+白蛋白紫杉醇 较好 (1)白蛋白紫杉醇125 mg/m2静脉滴注,第1、8、15天
    (2)吉西他滨1000 mg/m2静脉滴注大于30 min,第1、8、15天
    以上方案每4周重复1次
    (1)白蛋白紫杉醇125 mg/m2静脉滴注,第1、8天
    (2)吉西他滨1000 mg/m2静脉滴注大于30 min,第1、8天
    以上方案每3周重复1次
    吉西他滨+替吉奥 较好 (1)吉西他滨1000 mg/m2静脉滴注大于30 min,第1、8天
    (2)替吉奥:体表面积<1.25 m2,每次40 mg;体表面积≥1.25 m2且<1.5 m2,每次50 mg;体表面积≥1.5 m2,每次60 mg,口服,2次/d,第1~14天
    以上方案每3周重复1次
    (1)吉西他滨1000 mg/m2静脉滴注大于30 min,第1、8天
    (2)替吉奥:体表面积<1.25 m2,每次30 mg;体表面积≥1.25 m2且<1.5m2,每次40 mg;体表面积≥1.5 m2,每次50 mg,口服,2次/d,第1~14天
    以上方案每3周重复1次
    吉西他滨为基础的放化疗 较差 (1)化疗:吉西他滨1000 mg/m2静脉滴注大于30 min,第1、8、15天;每4周重复1次
    (2)放疗:2.4 Gy/F,15次,总量36 Gy
    (1)化疗:吉西他滨1000 mg/m2静脉滴注大于30 min,第1、8天;每3周重复1次
    (2)放疗:2.4 Gy/F,15次,总量36 Gy
    下载: 导出CSV
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  • 收稿日期:  2020-09-11
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