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免疫检查点抑制剂治疗后疾病进展的临床特征及预后因素分析

郝 冀

摘要

免疫检查点抑制剂(ICIs)的问世为多种恶性肿瘤的治疗带来了革命性突破,然而仍有相当比例的患者在治疗后出现疾病进展,包括原发性耐药和获得性耐药两种情形。部分患者甚至在治疗早期出现肿瘤加速生长的超进展现象,预后极差。本文系统综述了ICIs治疗后疾病进展的临床特征、进展模式及预后相关因素。耐药机制涉及肿瘤内在因素和外在因素的复杂交互网络,包括抗原呈递障碍、免疫抑制性微环境、T细胞耗竭等。超进展作为一种特殊的进展模式,其发生率约为6%~29%,与肝转移、基线肿瘤负荷大、高乳酸脱氢酶水平等因素密切相关。在预后评估方面,免疫谱评分、可溶性PD-1等新型生物标志物展现出了良好的应用前景。理解这些临床特征和预后因素,对于优化患者筛选、早期识别高风险人群及制定个体化治疗策略具有重要意义。

关键词

免疫检查点抑制剂;疾病进展;超进展;耐药机制;预后因素

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参考

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