查看“食管鳞癌”的源代码

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            <strong>[[食管鳞癌]]([[ESCC]])</strong>是起源于食管鳞状上皮的恶性肿瘤，是全球范围内、特别是亚洲地区最常见的食管癌病理类型（占比超过90%）。其发病常与慢性炎症刺激（如热食、烟酒习惯）及遗传易感性密切相关。在2026年的肿瘤学临床实践中，[[ESCC]]已全面进入“免疫联合时代”。通过对<strong>[[PD-L1]]</strong>表达、<strong>[[TMB]]</strong>及基因组特征的深度剖析，临床医生已能实现在围手术期（新辅助/辅助治疗）及晚期一线治疗中的精准决策。特别是以<strong>[[替雷利珠单抗]]</strong>为代表的[[PD-1]]抑制剂的应用，显著改写了[[ESCC]]患者的长期生存预后。
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            <div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">食管鳞癌</div>
            <div style="font-size: 0.7em; opacity: 0.85; margin-top: 4px; white-space: nowrap;">Esophageal Squamous Cell Carcinoma·点击展开</div>
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                <div style="font-size: 0.8em; color: #64748b; margin-top: 12px; font-weight: 600;">核心驱动基因：[[TP53]]•[[CCND1]]</div>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; width: 40%;">[[ICD-10]]</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">C15</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">[[Entrez]]ID</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">7157([[TP53]])</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">[[HGNC]]编号</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">11998</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">关键靶点</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[PD-1]]•[[EGFR]]•[[FGFR]]</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">主要筛查项</th>
                    <td style="padding: 10px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">染色内镜检查</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569;">2026状态</th>
                    <td style="padding: 12px; color: #1e40af;">化免联合及去化疗方案探索</td>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">发病机制：基因组不稳定与微环境抑制</h2>
    
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        [[食管鳞癌]]的发生是多阶段、多基因参与的复杂过程。2026年的分子生物学共识将其驱动机制细化为：
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        <li style="margin-bottom: 12px;"><strong>驱动突变特征：</strong>
            超过90%的[[ESCC]]存在<strong>[[TP53]]</strong>基因突变。此外，<strong>[[CCND1]]</strong>（细胞周期蛋白D1）的扩增以及<strong>[[CDKN2A]]</strong>的缺失导致细胞周期调控失控。</li>
        <li style="margin-bottom: 12px;"><strong>免疫逃逸路径：</strong>
            肿瘤细胞通过上调[[PD-L1]]表达，结合浸润T细胞表面的[[PD-1]]，诱导产生免疫抑制微环境。2026年研究发现，[[ESCC]]常伴有高度的<strong>[[TIGIT]]</strong>表达，这为双免疫治疗提供了分子基础。</li>
        <li style="margin-bottom: 12px;"><strong>代谢重构：</strong>
            最新的代谢组学研究揭示，[[ESCC]]细胞通过重排<strong>[[谷氨酰胺]]</strong>代谢路径，在低氧环境中维持极高的增殖潜能。</li>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">2026临床分期与一线诊疗推荐</h2>

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                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #0f172a; width: 25%;">临床场景</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #475569;">2026核心方案推荐</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #1e40af;">关键证据(试验名称)</th>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">局晚期可手术(cT1b-T4a)</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>化免联合新辅助</strong>治疗+手术。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">[[NICE研究]]/[[NEOTIS]]。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">晚期/转移性(一线)</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">[[PD-1]]抑制剂(如[[百泽安]])+含铂双药化疗。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">[[RATIONALE-306]]/[[ESCORT-1st]]。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">术后辅助(残余病灶)</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>[[欧司珀利单抗]]</strong>联合PD-1(探索中)或PD-1单药。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">[[CheckMate-577]]长效随访。</td>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">2026治疗策略：全病程管理与精准增效</h2>
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        [[食管鳞癌]]的治疗策略已从单一手段转向多学科协作([[MDT]])指导下的个体化模式：
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        <li style="margin-bottom: 12px;"><strong>围手术期全覆盖：</strong> 2026版指南强调，新辅助免疫治疗后达到病理完全缓解([[pCR]])的患者，其五年生存率可显著提升。对于R0切除后仍有残余病灶者，推荐序贯免疫维持。</li>
        <li style="margin-bottom: 12px;"><strong>双免疫靶向突破：</strong> 针对[[PD-L1]]低表达人群，2026年的前沿方案探索了[[PD-1]]联合<strong>[[TIGIT]]</strong>或<strong>[[CTLA-4]]</strong>的无化疗/减毒方案，以降低化疗相关副作用。</li>
        <li style="margin-bottom: 12px;"><strong>抗血管生成协同：</strong> [[PD-1]]抑制剂联合小分子<strong>[[VEGFR]]</strong>抑制剂（如[[阿帕替尼]]）在后线挽救治疗中展现了协同增效，有效逆转了部分免疫耐药。</li>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">关键相关概念</h2>
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            <li style="margin-bottom: 8px;"><strong>[[替雷利珠单抗]]([[百泽安]])：</strong> 2026年[[ESCC]]一线治疗的核心免疫药物。</li>
            <li style="margin-bottom: 8px;"><strong>[[CPS评分]]：</strong> 综合阳性评分，预测免疫治疗获益的关键生物标志物。</li>
            <li style="margin-bottom: 8px;"><strong>[[Siewert分型]]：</strong> 用于鉴别[[ESCC]]与食管胃交界部腺癌的外科分类标准。</li>
            <li style="margin-bottom: 8px;"><strong>[[淋巴结跳跃式转移]]：</strong> [[ESCC]]独特的生物学行为，决定了扩大的手术清扫范围。</li>
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        <span style="color: #0f172a; font-weight: bold; font-size: 1.05em; display: inline-block; margin-bottom: 15px;">学术参考文献与权威点评</span>
        
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            [1] <strong>NCCN Clinical Practice Guidelines in Oncology (2026 Version).</strong> <em>Esophageal and Esophagogastric Junction Cancers: Focus on Squamous Cell Carcinoma.</em><br>
            <span style="color: #475569;">[权威点评]：2026版指南明确了免疫检查点抑制剂在[[ESCC]]全线治疗中的不可替代地位。</span>
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            [2] <strong>[[Xu J]],et al.(2023/2026Update).</strong> <em>Tislelizumab plus chemotherapy vs chemotherapy as first-line treatment for advanced or metastatic esophageal squamous cell carcinoma (RATIONALE-306):A randomized phase 3 trial.</em> <strong>[[The Lancet Oncology]]</strong>.[Academic Review]<br>
            <span style="color: #475569;">[学术点评]：该项具有分水岭意义的研究证实，联合方案无论[[PD-L1]]状态如何，均能显著改善亚洲患者的生存质量。</span>
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            食管鳞癌 (ESCC) · 知识图谱
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">关联靶点</td>
                <td style="padding: 10px 15px; color: #334155;">[[PD-1]]•[[TIGIT]]•[[VEGFR2]]•[[EGFR]]•[[FGFR]]</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">核心药物</td>
                <td style="padding: 10px 15px; color: #334155;">[[替雷利珠单抗]]•[[帕博利珠单抗]]•[[卡瑞利珠单抗]]•[[阿帕替尼]]</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">诊断技术</td>
                <td style="padding: 10px 15px; color: #334155;">[[EUS]]•[[PET-CT]]•[[窄带成像技术(NBI)]]•[[液体活检]]</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">核心研究</td>
                <td style="padding: 10px 15px; color: #334155;">[[RATIONALE-306]]•[[KEYNOTE-590]]•[[ESCORT-1st]]•[[CheckMate-648]]</td>
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