食管癌内科治疗的现状与进展

doi:10.3760/cma.j.cn371439-20250704-00040

摘要/Abstract

摘要：

随着免疫治疗与靶向治疗的突破，食管癌的系统治疗格局已发生深刻变革。在可切除局部晚期食管癌中，新辅助治疗模式持续优化；对于不可切除局部晚期患者，根治性同步放化疗仍为标准治疗，后续免疫巩固的探索正在推进。转移性或复发性食管癌的一线治疗已进入免疫联合化疗时代，显著改善患者生存；后线治疗方面，免疫单药在特定人群中显示出优于化疗的疗效，同时针对HER2、Claudin 18.2、FGFR2b等靶点的精准治疗亦为特定患者提供了新的选择。分析不同病程阶段（可切除、不可切除、转移/复发）及不同亚型（鳞状细胞癌和腺癌）食管癌的内科治疗进展，系统梳理关键临床证据与当前挑战，可为临床实践提供参考。

关键词: 食管肿瘤, 药物疗法, 免疫疗法, 分子靶向治疗

Abstract:

The systemic treatment landscape has undergone profound transformation with breakthroughs in immunotherapy and targeted therapy. In cases of resectable locally advanced esophageal cancer， neoadjuvant therapy strategies continue to be optimized. For patients with unresectable locally advanced cancer， definitive concurrent chemoradiotherapy remains the standard treatment， and the exploration of subsequent immunotherapy consolidation is ongoing. First-line treatment for metastatic or recurrent esophageal cancer has entered the era of immunotherapy combined with chemotherapy， which has significantly improved patient survival. In terms of later-line treatment， immunotherapy alone has shown superior efficacy to chemotherapy in specific populations. Meanwhile， precise treatments targeting HER2， Claudin 18.2， FGFR2b， etc. have also provided new options for selected patients.Analyzing the progress of medical management of esophageal cancer across different disease stages （resectable， unresectable， metastatic or recurrent） and histological subtypes （squamous cell carcinoma and adenocarcinoma）， along with systematically reviewing key clinical evidence and current challenges， aims to provide reference for clinical practice.

Key words: Esophageal neoplasms, Drug therapy, Immunotherapy, Molecular targeted therapy

仝心雨, 杨静, 王明磊, 黄承锁, 罗应舒, 彭洁琼, 韩淑梅, 刘波. 食管癌内科治疗的现状与进展[J]. 国际肿瘤学杂志, 2026, 53(4): 240-247.

Tong Xinyu, Yang Jing, Wang Minglei, Huang Chengsuo, Luo Yingshu, Peng Jieqiong, Han Shumei, Liu Bo. Current status and advances in the medical treatment of esophageal cancer[J]. Journal of International Oncology, 2026, 53(4): 240-247.

图/表 1

表1

转移性或复发食管癌一线免疫治疗或靶向治疗的关键临床试验"

试验名称/编号	研究对象（例数）	治疗方案	中位OS（月）	中位PFS（月）	作者
免疫治疗+化疗比化疗
CheckMate 648	ESCC（n=970）	纳武利尤单抗+化疗（顺铂+氟尿嘧啶）比化疗	13.2比10.7（HR=0.74， 99.1%CI为0.58~0.96）	5.8比5.6（HR=0.81， 98.5%CI为0.64~1.04）	Doki等^[34]
		纳武利尤单抗+伊匹木单抗比化疗	12.7比10.7（HR=0.78， 98.2%CI为0.62~0.98）	2.9比5.6（HR=1.26， 95%CI为1.04~1.52）
ESCORT-1st	ESCC（n=596）	卡瑞利珠单抗+化疗（顺铂+紫杉醇）比安慰剂+化疗	15.6比12.6（HR=0.70， 95%CI为0.58~0.84）	7.6比5.8（HR=0.54， 95%CI为0.45~0.65）	He等^[35]
SKYSCRAPER-08	ESCC（n=461）	tiragolumab+阿替利珠单抗+化疗（顺铂+紫杉醇）比安慰剂+化疗	15.7比11.1（HR=0.70， 95%CI为0.55~0.88）	6.2比5.4（HR=0.56， 95%CI为0.45~0.70）	Hsu等^[36]
KEYNOTE-590	ESCC（n=548）， E/GEJ腺癌（n=201）	帕博利珠单抗+化疗（顺铂+氟尿嘧啶）比安慰剂+化疗	12.4比9.8（HR=0.73， 95%CI为0.62~0.86）	6.3比5.8（HR=0.65， 95%CI为0.55~0.76）	Metges等^[37]
KEYNOTE-859	HER2阴性 G/GEJ腺癌（n=1 568）	帕博利珠单抗+化疗（顺铂+氟尿嘧啶，或奥沙利铂+卡培他滨）比安慰剂+化疗	12.9比11.5（HR=0.78， 95%CI为0.70~0.87）	6.9 比 5.6，HR=0.76 （95%CI为0.67~0.85）	Rha等^[38]
CheckMate 649	HER2阴性 G/E/GEJ腺癌（n=1 581）	纳武利尤单抗+化疗（奥沙利铂+氟尿嘧啶+亚叶酸钙，或奥沙利铂+卡培他滨）比化疗	13.8比11.6，（HR=0.80， 99.3%CI为0.68~0.94）	7.7比6.9，（HR=0.77， 95%CI为0.68~0.87）	Janjigian等^[39]
COMPASSION-15	HER2阴性 G/GEJ腺癌（n=610）	卡度尼利单抗+化疗（奥沙利铂+卡培他滨）比安慰剂+化疗	14.1比11.1（HR=0.66， 95%CI为0.54~0.81）	7.0比5.3（HR=0.53， 95%CI为4.5~5.6）	Shen等^[40]
靶向治疗+化疗比化疗
ToGA	HER2阳性 G/GEJ腺癌（n=584）	曲妥珠单抗+化疗（顺铂+卡培他滨/氟尿嘧啶）比化疗	13.8比11.1（HR=0.74， 95%CI为0.60~0.91）	6.7比5.5（HR=0.71， 95%CI为0.59~0.85）	Bang等^[41]
GLOW	Claudin18.2阳性、 HER2阴性G/GEJ腺癌（n=507）	佐妥昔单抗+化疗（奥沙利铂+卡培他滨）比安慰剂+化疗	14.39比12.16（HR=0.771，95%CI为 0.615~0.965）	8.21比6.80（HR=0.687， 95%CI为0.544~0.866）	Shah等^[42]
SPOTLIGHT	Claudin18.2阳性、 HER2阴性G/GEJ腺癌（n=565）	佐妥昔单抗+化疗（奥沙利铂+氟尿嘧啶+亚叶酸钙/左旋亚叶酸钙）比安慰剂+化疗	18.23比15.54（HR=0.75， 95%CI为0.60~0.94）	10.61比8.67（HR=0.75， 95%CI为0.60~0.94）	Shitara等^[43]
免疫治疗+靶向治疗+ 化疗比靶向治疗+化疗
KEYNOTE-811	HER2阳性GEJ腺癌（n=698）	帕博利珠单抗+曲妥珠单抗+化疗（顺铂+氟尿嘧啶，或奥沙利铂+卡培他滨）比安慰剂+曲妥珠单抗+化疗	20.0比16.8（HR=0.84， 95%CI为0.70~1.01）	10.0比8.1（HR=0.73， 95%CI为0.61~0.87）	Janjigian等^[44]

表1

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