从ESMO共识看结直肠癌肝转移的治疗策略

肝脏转移是结直肠癌最常见的远处转移,大多数的结直肠癌肝转移患者为初始不可切除,为了获得最佳的治疗效果,需要在多学科团队的基础上,讨论并确定治疗策略和治疗目标。欧洲临床肿瘤学会指南被广泛用于结直肠癌患者治疗策略的制定,是临床医生需要遵循的标准。     

结直肠癌肝转移的治疗

结直肠癌肝转移是结直肠癌患者最主要的致死原因之一。结直肠癌肝转移的治疗方法很多,手术切除是其中的标准治疗方法,此外还有一些非手术治疗的方法,此文就结直肠癌肝转移的相关治疗方法作一综述。     

初始不可切除结直肠癌肝转移患者综合治疗进展

肝脏是结直肠癌最常见的远处转移部位。仅有约20%~30%的结直肠癌肝转移患者初始可切除,对于占绝大多数的潜在可切除和不可切除结直肠癌肝转移患者,如何通过化疗、靶向治疗、免疫治疗、手术治疗等综合治疗后获益,是结直肠肿瘤医师关注的重点。近年来,结直肠癌肝转移患者综合治疗取得了一定的进展。     

结直肠癌肝转移治疗的研究进展

结直肠癌肝转移的发生率和死亡率很高,是影响结直肠癌预后的重要因素.因此,找到合理的治疗方案显得尤为重要.目前手术切除仍被认为是唯一可能有效的治愈手段,但能手术根治的患者仅占少数.因此,随着医疗技术的发展,肝转移癌治疗经验的积累,多学科综合治疗理念逐渐被广泛应用,是确保结直肠癌肝转移患者获得最佳治疗策略的根本,亦是今后结直肠癌肝转移治疗的发展方向.多学科综合治疗方案包括手术切除、新辅助化疗、肝动脉化疗栓塞、放射疗法、射频消融术、冷冻疗法、无水乙醇注射术及中医药治疗等,一种或多种方法联合应用可明显提高患者的生存率并改善生活质量,本文对结直肠癌肝转移的综合治疗进展作一综述.     

结直肠癌肝转移的外科治疗

结直肠癌患者容易出现肝转移,肝转移是影响结直肠癌患者预后的主要原因之一.手术是目前治愈结直肠癌肝转移的唯一方法.本文主要总结了近年来结直肠癌肝转移患者肝转移病灶的手术进展情况:包括通过新辅助化疗或分阶段肝切除等方法提高肝转移病灶的手术切除率、肝转移灶切缘对患者预后的影响、同时性结直肠癌肝转移患者手术时机的选择、腹腔镜下...     

结直肠癌多发肝转移癌的治疗及生存因素分析

目的:探讨结直肠癌多发肝转移的治疗效果及生存因素分析.方法:将60例结直肠癌肝转移癌的患者纳入研究,根据治疗方法为手术组(n=30)非手术组(n=30).进行生存分析及Cox比例风险回归.结果:结直肠癌肝转移癌的手术组及非手术治疗的中位OS时间为30个月及6个月(P<0.05).两组对比1年、2年、3年生存率(P<0....     

结直肠癌肝转移的预后因素

目的:评价结直肠癌肝转移的临床预后因素及治疗方案对预后的影响.方法:收集71例结直肠癌肝转移患者的临床资料及预后情况,用Kaplan-Meier生存分析及Log-rank检验进行单因素分析,将有统计学意义的预后因素纳入Cox回归模型进行多因素分析.结果:Kaplan-Meier单因素分析及Log-rank检验显示,肝转移灶最大直径、有无区域淋巴结转移及诊断肝转移时碱性磷酸酶(ALP)最高值3个因素对其预后影响有显著意义;将这3个预后因素纳入Cox回归多因素分析显示,有无区域淋巴结转移、诊断肝转移时ALP最高值是结直肠癌肝转移的独立预后因素.全组3种治疗方式比较差别无统计学意义,但对手术切除组和化疗组两组进行比较,差异有统计学意义(P<0.05),而局部治疗组和手术组之间,局部治疗组和化疗组之间差别无统计学意义.结论:肝转移灶最大直径、原发病灶有无区域淋巴结转移、诊断肝转移时最高ALP值是结直肠癌肝转移患者的预后因素;肝转移灶最大直径越小、无区域淋巴结转移、诊断肝转移时最高ALP值正常的患者预后越好;手术切除联合化疗目前是结直肠癌肝转移的首选治疗方案,可获得较好的远期生存.     

结直肠癌肝转移的治疗策略

结直肠癌是消化系统的高发恶性肿瘤，其发病率和死亡率在我国大多数地区排名第3和第6位。也是全球癌症导致死亡的主要原因之一。肝脏是结直肠癌的常见转移部位。在新发的结直肠癌病例中．20％-25％存在肝转移，而在经手术切除的结直肠癌病例中，40％-50％最终会发生肝转移。随着新的强效化疗药物、分子靶向药物的问世、新治疗方法的出现以及外科手术技能的不断提高，结直肠癌肝转移患也获得了更多的治疗选择及更好的生存预后。     

结直肠癌肝转移的治疗进展

结直肠癌的发病率和死亡率逐年上升,肝转移是主要死因。本文阐述了目前临床上使用较多的治疗方式及进展。分为系统性治疗,包括了新辅助化疗、转化治疗和分子靶向治疗;及局部治疗,包括手术切除、放射治疗、射频消融及介入治疗等。各种治疗手段各有优缺点,多学科综合治疗团队模式的推广,将为结直肠癌肝转移患者制定出较适合的方案,实现个体化治疗。     

Current treatment for colorectal liver metastases

Surgical resection offers the best opportunity for survival in patients with colorectal cancer metastatic to the liver,with five-year survival rates up to 58% in selected cases.However,only a minority are resectable at the time of diagnosis.Continuous research in this field aims at increasing the percentage of patients eligible for resection,refining the indications and contraindications for surgery,and improving overall survival.The use of surgical innovations,such as staged resection,portal vein embolizat...     

多学科协作诊治模式下治疗不可切除结直肠癌67例

目的:总结多学科协作诊治模式下治疗不可切除结直肠癌的经验.方法:本研究纳入67例符合条件的患者,其中男38例,女29例,平均年龄为55.62岁,右半结肠癌15例,左半结肠癌9例,直肠癌43例.67例患者均经综合治疗小组评估为不可切除,且组织学证实为结直肠癌.患者的治疗由结直肠专科医师与多学科组成的综合治疗小组完成.结果:67例患者中,无完全缓解(CR)病例,部分缓解(PR)43例,稳定(ND)16例,进展(PD)8例;近期症状缓解率100%;生存期10-38mo,平均24mo;9例患者实施了根治性手术,外科干预比例为13.4%(9/67);总并发症发生率为52.2%(35/67).结论:采用综合治疗方式,包括全身化疗、介入化疗、局部放疗、分子靶向治疗、中医中药治疗、手术治疗以及针对病灶的局部治疗,可提高不可切除结直肠癌患者的生存质量,延长存活时间.     

Evaluation of aggressively treated patients with unresectable multiple liver metastases from colorectal cancer

PURPOSE: The aim of this study was to assess the value of aggressively treating patients with unresectable liver metastases from colorectal cancer and a poor prognosis. METHODS: From 1988 to 1999, 64 patients with unresectable multiple liver metastases from colorectal cancer who had received hepatic arterial infusion chemotherapy were investigated. All patients did not have synchronous extrahepatic metastases at the time of initiating our treatment. When liver metastases were suitable for resection after hepatic arterial infusion chemotherapy, we excised them and repeated prophylactic hepatic arterial infusion chemotherapy as long as possible. We evaluated the efficacy of hepatic arterial infusion chemotherapy by computed tomography and divided these patients into responders and nonresponders. We performed univariate analysis using the log-rank test to calculate predictive factors. In addition, the Cox proportional hazards model was used to perform multivariate analysis of factors related to survival. RESULTS: The survival rate of all patients was 67.8 percent after 1 year and 10 percent after 5 years. However, the survival rate for 16 patients who received hepatectomy after hepatic arterial infusion chemotherapy was 35.1 percent after five years. Multivariate analysis demonstrated that the response after hepatic arterial infusion chemotherapy was the most indicative prognostic factor. CONCLUSIONS: The prognosis of selected patients who responded to hepatic arterial infusion chemotherapy and received hepatectomy was improved. Applying aggressive treatment as outlined in our strategy may improve the chances of long-term survival.     

Colorectal cancer with liver metastases: Neoadjuvant chemotherapy,surgical resection first or palliation alone?

Colorectal cancer (CRC) is one of the commonest cancers with 1.2 million new cases diagnosed each year in the world. It remains the fourth most common cause of cancer-related mortality in the world and accounts for > 600000 cancer-related deaths each year. There have been significant advances in treatment of metastatic CRC in last decade or so, due to availability of new active targeted agents and more aggressive approach towards the management of CRC, particularly with liver-only-metastases; however, these drugs work best when combined with conventional chemotherapy agents. Despite these advances, there is a lack of biomarkers to inform us about the accurate management of the patients with metastatic CRC. It is therefore imperative to carefully select the patients with comprehensive multi-disciplinary team input in order to optimise the management of these patients. In this review we will discuss various treatment options available in management of colorectal liver metastases with potential guidance on how and when to choose these options along with consideration on future directions in management of this disease.     

中山医院结直肠癌MDT讨论治疗策略分析

目的分析结直肠癌多学科诊疗团队（MDT）讨论后制定的治疗策略。 方法回顾性分析2010年7月至2019年2月复旦大学附属中山医院进行MDT讨论的结直肠癌患者的临床资料,对MDT讨论结果进行统计分析。 结果结直肠癌MDT总计为1 953例结直肠癌患者进行4 535人次讨论制定个体化治疗方案。其中,553例患者肝转移灶和111例患者肺转移灶被认为可切除。另有261位最初不可切除的结直肠癌肝转移患者,在接受系统化疗联合分子靶向以及介入等综合治疗后,转化为可切除,建议接受肝转移灶切除手术。实际上总计772位结直肠癌患者接受肝转移灶切除,其中同时性肝转移患者有581例,而接受结直肠癌原发灶和肝转移灶同步切除的患者有248例。肝切除手术中仅有87例患者（11.3%）实施解剖性肝切除,绝大多数实施非解剖性肝切除。肝转移灶切除手术中联合射频消融的有62例（8.0%）。术后病理提示R1切除的有18位（2.3%）。 结论复杂结直肠癌病例推荐行MDT讨论。扩展手术适应证、应用二步肝切除术、联合射频消融等局部毁损治疗可以扩大肝转移灶手术的适应人群。初始无法手术切除的患者,如状况耐受,建议给予强烈的个体化转化治疗,争取转化后手术切除。