北京大学学报（医学版）2026，Vol.58Issue(2)：266-271,6.DOI:10.19723/j.issn.1671-167X.2026.02.007
免疫治疗背景下食管鳞状细胞癌围手术期治疗的临床思考
Clinical strategies for perioperative management of esophageal squamous cell carci-noma in the immunotherapy era
摘要
Abstract
Esophageal squamous cell carcinoma(ESCC)is a highly prevalent and lethal malignancy in China and other East Asian countries.For patients with locally advanced disease,neoadjuvant chemo-therapy or chemoradiotherapy followed by surgery has become the standard treatment paradigm.However,despite improvements in local tumor control and surgical outcomes,long-term survival remains unsatisfac-tory,largely due to the high incidence of distant metastasis and systemic disease progression.Therefore,optimizing perioperative systemic therapy represents a critical unmet clinical need in ESCC.In recent years,the introduction of immune checkpoint inhibitors(ICIs)has profoundly reshaped the perioperative treatment landscape of ESCC.This review comprehensively summarizes recent clinical advances in perio-perative immunotherapy for ESCC,including neoadjuvant immunotherapy alone,neoadjuvant immuno-therapy combined with chemotherapy,neoadjuvant immunotherapy combined with chemoradiotherapy,and postoperative adjuvant immunotherapy.Current data indicate that neoadjuvant chemoradiotherapy re-mains highly effective in improving local control,downstaging tumors,and increasing the rate of R0 re-section.Nevertheless,its ability to translate these advantages into durable survival benefit is limited,and distant recurrence remains a major cause of treatment failure.In contrast,neoadjuvant immunotherapy combined with chemotherapy has demonstrated a marked improvement in pathological complete response(pCR)rates across multiple early-phase trials.More importantly,this strategy appears to provide supe-rior systemic disease control,thereby reducing the risk of distant metastasis and offering a promising avenue for improving long-term survival.Neoadjuvant immunotherapy combined with chemoradiotherapy has shown further enhancement of local response and tumor regression;however,this approach is asso-ciated with increased treatment-related toxicity,and robust evidence supporting a clear survival advantage is still lacking.As a result,the optimal integration of radiotherapy into immunotherapy-based periopera-tive regimens remains an area of active investigation.Given the heterogeneity of ESCC,perioperative treatment strategies should evolve toward individualized,risk-adapted approaches.For patients with a high local tumor burden(advanced T stage),the incorporation of radiotherapy may be beneficial to rein-force local control and improve resectability.Conversely,for patients with extensive lymph node involve-ment(advanced N stage)and a high risk of distant relapse,immunotherapy-based systemic treatment should be prioritized.In the postoperative setting,adjuvant immunotherapy has been shown to improve outcomes in patients who fail to achieve pCR after neoadjuvant chemoradiotherapy.Looking forward,the integration of dynamic biomarkers,such as circulating tumor DNA(ctDNA),along with the identifica-tion of novel immune targets and predictive biomarkers,is expected to further refine patient selection and optimize precision perioperative treatment strategies for ESCC.关键词
食管鳞状细胞癌/围手术期治疗/新辅助免疫治疗/病理完全缓解Key words
Esophageal squamous cell carcinoma/Perioperative therapy/Neoadjuvant immunothera-py/Pathological complete response分类
医药卫生引用本文复制引用
付浩,申潞艳,黄冰洋,马少华..免疫治疗背景下食管鳞状细胞癌围手术期治疗的临床思考[J].北京大学学报（医学版）,2026,58(2):266-271,6.基金项目
北京研究型病房卓越计划项目(BRWEP2024W032150100、BRWEP2024W032150101)Supported by the Beijing Research Ward Ex-cellence Program(BRWEP2024W032150100,BRWEP2024W032150101) （BRWEP2024W032150100、BRWEP2024W032150101）
