引用文本：孙凯. 从“三明治”到“全程新辅助治疗”再到“全程新辅助联合免疫治疗”——浅谈局部进展期直肠癌治疗模式的逐步演变[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(4): 484-488.

作者：孙凯

单位：南方医科大学南方医院普外科，广东 广州 510515

Authors：Sun Kai

Unit：Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China

摘要：

术前同步放化疗序贯根治性全直肠系膜切除术及术后辅助化疗的“三 明治”模式仍是目前指南推荐的中低位局部进展期直肠癌（locally advanced rectal cancer，LARC）的标准治疗方案。然而，此种模式在带来局部复发率显著下降的同时，仍存在未被满足的临床需求，其中根治性手术导致的肛门功能障碍及器官毁损问题尤为突出。如何在确保新辅助治疗疗效的同时尽可能保留器官功能，已成为LARC临床实践亟待解决的关键问题。全程新辅助治疗（total neoadjuvant therapy，TNT）是指将术后辅助治疗提前至术前，即所有治疗均在术前完成，既可以提高患者治疗依从性，亦可以最大程度地缩小肿瘤病灶、消除潜在微转移灶，从而提高手术根治率，改善患者长期生存。而在此基础上以免疫检查点抑制剂为主要代表的免疫治疗的联合，即全程新辅助联合免疫治疗（immunotherapy-based total neoadjuvant therapy，iTNT）模式，更带来了完全缓解率的提升，有望实现更多的器官保留，甚至避免外科手术；但仍需格外关注联合治疗模式的安全性问题，尤其是免疫相关不良事件的全程管理和对手术并发症的潜在影响。本文旨在阐述近年来LARC新辅助治疗方案的理念更新和演进优化，以期为目前的临床实践提供参考。

关键词：局部进展期直肠癌；新辅助治疗；免疫检查点抑制剂

Abstract：

The "sandwich" regimen—preoperative concurrent chemoradiotherapy followed by total mesorectal excision (TME) and adjuvant chemotherapy—remains the standard-of-care for mid-to-low locally advanced rectal cancer (LARC). While effective in reducing local recurrence, this strategy is associated with significant functional sequelae, including anal dysfunction and organ impairment after radical surgery, highlighting an unmet need for organ-preserving strategies. Total neoadjuvant therapy (TNT), which delivers all chemotherapy prior to surgery, has emerged to enhance treatment compliance, tumor regression, and micrometastasis eradication, thereby improving surgical outcomes and survival. More recently, the incorporation of immune checkpoint inhibitors, termed immunotherapy-based total neoadjuvant therapy (iTNT), has shown potential to further increase complete response rates, enabling non-operative management in selected patients. However, the safety profile of combination therapies, particularly immune-related adverse events and their implications for surgical complications, warrants careful consideration. This review outlines recent advances and evolving paradigms in neoadjuvant therapy for LARC, providing insights for contemporary clinical practice.

Key words：Locally advanced rectal cancer; Neoadjuvant treatment; Immune checkpoint inhibitors

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