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外科视角下腹膜后肿瘤诊疗体系的创新整合与临床转化进展
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Abstract:
腹膜后肿瘤是一类发生在复杂解剖间隙的肿瘤类别，兼具临床诊治挑战性与科研发掘价值性。本文系统梳理了腹膜后肿瘤的基础特征与诊疗进展：1) 解剖学层面，腹膜后间隙包含多脏器与神经血管结构，其潜在腔隙特性导致肿瘤生长隐匿且易广泛粘连，约50%患者确诊即晚期；2) 病理分型涵盖15类组织来源，其中恶性肿瘤占80%，以脂肪肉瘤(33%)、平滑肌肉瘤最为常见；3) 诊断体系依赖多模态影像技术(CT/MRI定位准确率85%)、液体活检及人工智能辅助分析，但早期诊断仍面临特异性生物标志物缺失的瓶颈；4) 治疗策略以根治性切除为核心(R0切除率68.4%)，联合新辅助放化疗(5年生存率提升12%~28%)、靶向治疗(如MDM2/CDK4抑制剂)及免疫治疗形成MDT模式，但巨大肿瘤(>10 cm)的R0切除率仅25%；5) 预后受多重因素影响，肿瘤分期(III期5年生存率40%~50%)、切除程度(R0与R2切除生存率相差3倍)及分子分型构成关键变量。未来研究将聚焦于肿瘤微环境调控机制解析、基于影像组学的术前精准评估体系构建，以及新型治疗靶点(如PPAR-γ激动剂、海洋化合物)的临床转化，以期突破当前诊疗困境。
Retroperitoneal tumors are a type of tumor that occurs in complex anatomical gaps, which have both the challenges of clinical diagnosis and treatment and the value of scientific research and development. This paper systematically sorts out the basic characteristics and diagnosis and treatment progress of retroperitoneal tumors: 1) At the anatomical level, the retroperitoneal space contains multiple organs and neurovascular structures, and its potential lacunarity causes tumor growth to be hidden and prone to widespread adhesions. About 50% of patients are diagnosed as advanced; 2) Pathological typing covers 15 types of tissue sources, of which malignant tumors account for 80%, with liposarcoma (33%) and leiomyosarcoma being the most common; 3) The diagnostic system relies on multimodal imaging technology (85% accuracy of CT/MRI positioning), liquid biopsy and artificial intelligence-assisted analysis, but early diagnosis still faces bottlenecks of specific biomarker deletion; 4) The treatment strategy focuses on radical resection (R0 resection rate 68.4%), combined with neoadjuvant chemoradiation and chemotherapy (5-year survival rate increased by 12%~28%), targeted therapy (such as MDM2/CDK4 inhibitors) and immunotherapy formed an MDT pattern, but the R0 resection rate of huge tumors (>10 cm) was only 25%; 5) The prognosis was affected by multiple factors, and tumor stage (40%~50% of phase III 5-year survival rate), resection degree (3 times different survival rate of R0 and R2 resection) and molecular typing constituted key variables. Future research will focus on the analysis of tumor microenvironment regulation mechanisms, the construction of preoperative precise evaluation system based on imaging complications, and the clinical transformation of new therapeutic targets (such as PPAR-γ agonists and marine compounds), in order to break through the current diagnosis and treatment dilemma.
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