腸菌移植應用于腫瘤治療中國專家共識 (2025 年版)
摘要: 【摘要】 腸菌移植也稱糞菌移植 (fecalmicrobiotatransplantation,FMT),近年來 FMT 在腫瘤治療中的潛力逐漸受到關注。FMT可通過重建腸道菌群改善造血干細胞移植后腸道生態失衡、減少抗生素耐藥基因定植,且對艱難梭菌 ...
【摘要】 腸菌移植也稱糞菌移植 (fecalmicrobiotatransplantation,FMT),近年來 FMT 在腫瘤治療中的潛力逐漸受到關 注。FMT可通過重建腸道菌群改善造血干細胞移植后腸道生態失衡、減少抗生素耐藥基因定植,且對艱難梭菌感染及移 植物抗宿主病具有潛在療效。研究顯示 FMT可顯著提升腫瘤患者腸道菌群多樣性,與免疫檢查點抑制劑聯用可增強抗腫 瘤療效,但其機制仍需深入探索,臨床應用仍面臨諸多挑戰。目前 FMT 臨床研究存在明顯局限性,普遍缺乏高質量雙盲 隨機對照試驗,且標準化流程如供體篩選、劑量選擇等尚未統,直接影響證據等級及臨床推廣。本專家共識基于現有循 證醫學證據及臨床實踐經驗,系統總結了 FMT在腫瘤治療中的關鍵作用與局限性,提出18項具體陳述,涵蓋 FMT 在腫 瘤治療相關并發癥及聯合治療中的應用推薦,強調需基于個體化治療原則優化方案。 【關鍵詞】 腸菌移植;造血干細胞移植;移植物抗宿主病;免疫治療;專家共識 Chineseexpertconsensusonapplicationoffecalmicrobiotatransplantationincancertherapy(2025edition) Committeeof Cancerand Microecology,Chinese AntiCancer Association(CACA);Tumorand Microecology Specialty CommitteeofHubeiAcademyofImmunology Correspondingauthor:GuoZhi,Email:guozhi77@126.com;WangQiang,Email:wangqiang@wust.edu.cn 【Abstract】 Fecalmicrobiotatransplantation(FMT),alsoknownasintestinalmicrobiotatransplantation,hasrecentlygarnered increasingattentionforitspotentialincancertreatment.FMTdemonstratessignificantclinicalbenefitsthroughgutmicrobiota reconstruction,includingamelioratingintestinaldysbiosisafterhematopoieticstem celltransplantation,reducingantibiotic resistancegenecolonization,andexhibitingtherapeuticpotentialforClostridium difficileinfectionand graftversushost disease.ClinicalevidenceindicatesthatFMTsignificantlyenhancesgutmicrobiotadiversityincancerpatientsandpotentiates antitumorefficacywhencombinedwithimmunecheckpointinhibitors,althoughtheunderlying mechanismsrequirefurther elucidation.Currently,clinicalstudiesonFMThavesignificantlimitations,particularlythepaucityofhighqualitydoubleblind randomizedcontrolledtrials(RCTs).Standardizationofcriticalprocedures,includingdonorscreeningprotocolsanddosage determination,remainsinconsistent,significantlyimpactingtheevidencehierarchyandclinicalimplementation.Thisexpert consensus,basedonevidencebased medicineandclinicalpractice,systematicallyevaluatesthepivotalroleandlimitationsof FMTincancertreatment.Thedocumentpresents18specificrecommendationsencompassingFMT applicationsincancer treatmentrelated complications and combination therapies,emphasizing the need of protocol optimization based on individualizedtreatmentprinciples. 【Keywords】 Fecal microbiota transplantation;Hematopoietic stem cell transplantation;Graftversushost disease; Immunotherapy;Expertconsensus |
