摘要
结直肠癌肝转移(CRLM)的发病率逐年升高。手术切除是CRLM患者获得长期生存最主要的手段,根治切除后的5年生存率约为50%。在初始就诊时只有20%的患者属于可切除,总体手术切除后复发率超过70%。随着有效化疗药物及靶向药物的出现,围手术期化疗得到了广泛应用。对于初始可切除肝转移患者,通过围手术期化疗可能有助于降低复发、延长生存。而对于初始不可切除的患者,则可以通过强力的化疗使部分患者转化为可切除并进行根治手术。但是由于CRLM预后影响因素众多,异质性高,很多问题缺乏大样本前瞻性的临床试验证据。因此,围手术期化疗的临床实践仍然存在许多争议,包括单纯化疗是否为可切除肝转移的最佳术前治疗方案、新辅助化疗联合靶向治疗是否优于单纯化疗、哪些人群是化疗联合靶向治疗的获益人群、哪些人群是转化治疗的人群、一线治疗如何选择转化治疗方案等。本文详细阐述了CRLM围手期新辅助化疗、转化治疗和辅助化疗的研究现状,并强调CRLM是一种全身性疾病,在为CRLM患者进行治疗决策时,需要多学科团队协作,结合患者的具体情况进行个体化的诊治。
The incidence of colorectal cancer liver metastasis (CRLM) increased gradually in recent years. Surgical resection is the most important treatment for CRLM patients to obtain long-term survival, with a 5-year survival rate of about 50%. However, only 20% of the CRLM patients are initially resectable. The recurrence rate after surgery is more than 70%. Perioperative chemotherapy has been widely used with the development of effective chemotherapy regimens and targeted therapies. For patients with initially resectable liver metastases, perioperative chemotherapy may help reduce recurrence and prolong survival. For patients with unresectable liver metastases, conversion chemotherapy with high efficiency provides opportunity for radical resection. However, CRLM is a disease with high heterogeneity and with many factors influencing prognosis, and there is a lack of large-scale prospective clinical trial evidence in many problems. Hence there are still many controversies in the clinical practice of perioperative chemotherapy, including whether chemotherapy alone is the best preoperative treatment for resectable CRLM, whether preoperative chemotherapy combined with targeted therapy is superior to chemotherapy alone, who can benefit most from preoperative chemotherapy combined with targeted therapy, who are the exact patients suitable for conversion therapy, how to choose the best first-line conversion therapy. Here we discuss the current status of research on perioperative chemotherapy in three aspects: neoadjuvant chemotherapy, conversion therapy and adjuvant chemotherapy. We also emphasized the importance of multidisciplinary team during the treatment process to give patients individualized therapy considering their specific conditions.
作者
徐达
邢宝才
Xu Da;Xing Baocai(Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and histitute, Beijing 100142, China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2019年第4期321-328,共8页
Chinese Journal of Gastrointestinal Surgery
关键词
结直肠肿瘤
转移
肝
手术
化疗
Colorectal neoplasms
Metastasis, liver
Surgery
Chemotherapy
