免疫检查点抑制剂在肝胆胰脾外科肿瘤中的应用研究进展
Research Progress on the Application of Immune Checkpoint Inhibitors in Hepatobiliary and Pancreatic Surgery Tumors

肝胆胰脾外科肿瘤因确诊时多为中晚期、术后复发率高及传统治疗局限性，导致患者预后普遍不佳。免疫检查点抑制剂(ICIs)通过阻断CTLA-4、PD-1/PD-L1等免疫检查点通路，解除肿瘤免疫逃逸，为该类肿瘤治疗带来突破。本文综述ICIs在肝细胞癌、胆管癌、胰腺癌及脾脏肿瘤中的应用进展：肝细胞癌中ICIs联合抗血管生成药物已成晚期一线标准方案，围手术期应用前景良好；胆管癌和胰腺癌中ICIs联合化疗等方案显著改善疗效；脾脏肿瘤中ICIs显潜力但证据有限。同时分析ICIs应用面临的疗效预测标志物缺乏、耐药及免疫相关不良反应(irAEs)等挑战，并展望精准免疫治疗、新型联合方案等未来方向。旨在为ICIs在肝胆胰脾外科肿瘤中的临床应用及研究提供参考。
Surgical tumors of the hepatobiliary, pancreatic and splenic system are generally associated with poor prognosis in patients, primarily due to late diagnosis at advanced stages, high postoperative recurrence rates, and the limitations of traditional therapeutic approaches. Immune checkpoint inhibitors (ICIs) have achieved breakthroughs in the treatment of such tumors by blocking immune checkpoint pathways (e.g., CTLA-4, PD-1/PD-L1) to reverse tumor immune escape. This article reviews the progress in the application of ICIs for hepatocellular carcinoma, cholangiocarcinoma, pancreatic cancer, and splenic tumors: in hepatocellular carcinoma, ICIs combined with anti-angiogenic drugs have become the first-line standard regimen for advanced cases, with promising prospects for perioperative application; in cholangiocarcinoma and pancreatic cancer, regimens such as ICIs combined with chemotherapy have significantly improved therapeutic efficacy; ICIs show potential in the treatment of splenic tumors but are supported by limited evidence. Additionally, this article analyzes the challenges in the application of ICIs, including the lack of predictive biomarkers for therapeutic efficacy, drug resistance, and immune-related adverse events (irAEs), and prospects future directions such as precision immunotherapy and novel combination regimens. The aim is to provide a reference for the clinical application and research of ICIs in surgical tumors of the hepatobiliary, pancreatic and splenic system.