肠菌移植应用于肿瘤治疗中国专家共识 (2025 年版)
摘要: 【摘要】 肠菌移植也称粪菌移植 (fecalmicrobiotatransplantation,FMT),近年来 FMT 在肿瘤治疗中的潜力逐渐受到关注。FMT可通过重建肠道菌群改善造血干细胞移植后肠道生态失衡、减少抗生素耐药基因定植,且对艰难梭菌 ...
【摘要】 肠菌移植也称粪菌移植 (fecalmicrobiotatransplantation,FMT),近年来 FMT 在肿瘤治疗中的潜力逐渐受到关 注。FMT可通过重建肠道菌群改善造血干细胞移植后肠道生态失衡、减少抗生素耐药基因定植,且对艰难梭菌感染及移 植物抗宿主病具有潜在疗效。研究显示 FMT可显著提升肿瘤患者肠道菌群多样性,与免疫检查点抑制剂联用可增强抗肿 瘤疗效,但其机制仍需深入探索,临床应用仍面临诸多挑战。目前 FMT 临床研究存在明显局限性,普遍缺乏高质量双盲 随机对照试验,且标准化流程如供体筛选、剂量选择等尚未统,直接影响证据等级及临床推广。本专家共识基于现有循 证医学证据及临床实践经验,系统总结了 FMT在肿瘤治疗中的关键作用与局限性,提出18项具体陈述,涵盖 FMT 在肿 瘤治疗相关并发症及联合治疗中的应用推荐,强调需基于个体化治疗原则优化方案。 【关键词】 肠菌移植;造血干细胞移植;移植物抗宿主病;免疫治疗;专家共识 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 |
