Combining surgery and immunotherapy: turning an immunosuppressive effect into a therapeutic opportunity.
Combining surgery and immunotherapy: turning an immunosuppressive effect into a therapeutic opportunity.
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DOI：
10.1186/s40425-018-0398-7
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发表时间：
2018-09-03
影响因子：
10.9
通讯作者：
Tai LH
中科院分区：
文献类型：
--
作者：
Bakos O;Lawson C;Rouleau S;Tai LH
癌症手术是必要的，可以挽救生命。然而，大多数患者术后复发和转移，这是癌症相关死亡的主要原因。术后应激反应包括一系列广泛的生理变化，这些变化已经演变为在重大组织创伤后保护宿主。然而，这些应激反应与有助于癌症增殖的细胞介质和信号通路交叉。先前的描述性和新兴的机制研究表明，手术诱导的促转移作用与先天性和适应性免疫受损有关。将联合收割机手术和免疫疗法相结合的现有研究表明，这种联合策略并不简单，患者经历了治疗益处和缺点。本综述将专门评估肿瘤手术应激破坏的免疫途径，并为合理结合癌症手术与免疫治疗以改善免疫和治疗结果提供建议。鉴于手术作为实体瘤一线治疗的流行率，术后免疫抑制的新兴数据以及肿瘤治疗免疫治疗的快速发展，我们认为未来有必要对围手术期免疫治疗进行靶向研究。
Cancer surgery is necessary and life-saving. However, the majority of patients develop postoperative recurrence and metastasis, which are the main causes of cancer-related deaths. The postoperative stress response encompasses a broad set of physiological changes that have evolved to safeguard the host following major tissue trauma. These stress responses, however, intersect with cellular mediators and signaling pathways that contribute to cancer proliferation. Previous descriptive and emerging mechanistic studies suggest that the surgery-induced prometastatic effect is linked to impairment of both innate and adaptive immunity. Existing studies that combine surgery and immunotherapies have revealed that this combination strategy is not straightforward and patients have experienced both therapeutic benefit and drawbacks. This review will specifically assess the immunological pathways that are disrupted by oncologic surgical stress and provide suggestions for rationally combining cancer surgery with immunotherapies to improve immune and treatment outcomes. Given the prevalence of surgery as frontline therapy for solid cancers, the emerging data on postoperative immunosuppression and the rapid development of immunotherapy for oncologic treatment, we believe that future targeted studies of perioperative immunotherapy are warranted.
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