Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive and lethal human malignancies, with five-year survival rates showing only marginal improvement despite decades of intensive research. Its dismal prognosis reflects a combination of intrinsic biological aggressiveness, late clinical presentation, and marked resistance to standard therapies, underscoring the urgent need for innovative diagnostic and therapeutic approaches. Growing evidence indicates that the microbiome is a modifiable factor influencing the onset, progression, and treatment response of PDAC. Microbial communities originating from the gut, oral cavity, and even the tumor microenvironment can shape carcinogenic pathways, modulate immune activity, and alter the efficacy of chemotherapy and immunotherapy. In addition to bacteria, fungal and viral populations are emerging as relevant contributors within this complex ecosystem. This review provides a comprehensive overview of the current mechanistic and translational evidence linking the microbiome to PDAC biology and therapy. It further explores microbiota-targeted interventions—such as probiotics, postbiotics, engineered bacterial strains, bacteriophages, oncolytic viruses, and fecal microbiota transplantation—as promising adjuncts to conventional treatments. A deeper understanding of host–microbiome interactions could yield novel biomarkers and open innovative avenues for precision medicine in PDAC, ultimately improving patient outcomes and reshaping therapeutic paradigms. Integrating microbiome-based strategies into PDAC management may thus represent a crucial step toward more effective and personalized oncologic care.
胰腺导管腺癌（PDAC）作为最具侵袭性和致死性的人类恶性肿瘤之一，其五年生存率虽经数十年深入研究仍仅略有改善。其不良预后源于肿瘤内在的生物学侵袭性、临床发现较晚以及对标准治疗的显著抵抗，这凸显了对创新诊断与治疗方法的迫切需求。越来越多的证据表明，微生物组是影响PDAC发生、进展及治疗反应的可调控因素。源自肠道、口腔甚至肿瘤微环境的微生物群落能够影响致癌通路、调节免疫活性，并改变化疗和免疫疗法的疗效。除细菌外，真菌和病毒群体也正成为这一复杂生态系统中不可忽视的参与者。本综述全面概述了当前将微生物组与PDAC生物学及治疗联系起来的机制性和转化性证据，并进一步探讨了以微生物群为靶点的干预措施——如益生菌、后生元、工程菌株、噬菌体、溶瘤病毒和粪便微生物移植——作为传统治疗的有前景的辅助手段。深入理解宿主-微生物组相互作用，有望为PDAC带来新型生物标志物，并开辟精准医学的创新途径，最终改善患者预后并重塑治疗范式。因此，将基于微生物组的策略整合到PDAC管理中，可能代表着迈向更有效、更个性化肿瘤治疗的关键一步。
肿瘤(癌症)患者之家