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中华结直肠疾病电子杂志 ›› 2017, Vol. 06 ›› Issue (05) : 354 -359. doi: 10.3877/cma.j.issn.2095-3224.2017.05.001

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重视直肠癌的术前精准评估
徐惠绵1,(), 王鹏亮1   
  1. 1. 110001 沈阳,中国医科大学附属第一医院肿瘤外科
  • 收稿日期:2017-06-20 出版日期:2017-10-25
  • 通信作者: 徐惠绵
  • 基金资助:
    国家自然科学基金项目(No.81372550)

Emphasize on rectal cancer preoperative precise assessment

Huimian Xu1,(), Pengliang Wang1   

  1. 1. Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
  • Received:2017-06-20 Published:2017-10-25
  • Corresponding author: Huimian Xu
  • About author:
    Corresponding author: Xu Huimian, Email:
引用本文:

徐惠绵, 王鹏亮. 重视直肠癌的术前精准评估[J]. 中华结直肠疾病电子杂志, 2017, 06(05): 354-359.

Huimian Xu, Pengliang Wang. Emphasize on rectal cancer preoperative precise assessment[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(05): 354-359.

以往对于直肠癌患者术前评估主要关注的是手术方式的选择以及能否达到根治性切除。而近年来随着新辅助治疗及多学科诊疗模式等新技术在直肠癌临床实践中的应用,精准术前评估对患者也不仅限于手术方式选择、预后评估,更重要的是指导个体化综合治疗方案和流程的选择,使患者生存获益及生活质量提高。因此,精准的术前评估对于直肠癌患者显得尤为重要。本文旨在对直肠癌术前的精准评估做一概述,供临床医生借鉴。

In recent years, as some new technology applied in the clinical practice of rectal cancer, such as neoadjuvant therapy, multidisciplinary team (MDT) and so on, the influence of accurate preoperative assessment for patients is not only associated with operation selection and prognosis assessment, but also related with reasonable choice of personalized comprehensive treatment plan and process. Furthermore, it also can provide survival benefit and improve the quality of life for patients. Therefore, the precision preoperative assessment is critical for patients with rectal cancer. The purpose of this study is to given an overview to precision preoperative assessment of rectal cancer and provide reference for clinical oncologists.

[1]
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132.
[2]
陈万青,张思维,曾红梅, 等. 中国2010年恶性肿瘤发病与死亡[J]. 中国肿瘤, 2014, 23(01):1-10.
[3]
Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer[J]. N Engl J Med, 2004, 351(17):1731-1740.
[4]
Monson JR, Weiser MR, Buie WD, et al. Practice parameters for the management of rectal cancer (revised)[J]. Dis Colon Rectum, 2013, 56(5):535-550.
[5]
Bipat S, Glas AS, Slors FJ, et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging--a meta-analysis[J]. Radiology, 2004, 232(3):773-783.
[6]
Yamashita Y, Machi J, Shirouzu K, et al. Evaluation of endorectal ultrasound for the assessment of wall invasion of rectal cancer. Report of a case[J]. Dis Colon Rectum, 1988, 31(8):617-623.
[7]
Group MS, Shihab OC, Taylor F, et al. Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer[J]. Br J Surg, 2011, 98(12):1798-1804.
[8]
Kaur H, Choi H, You YN, et al. MR imaging for preoperative evaluation of primary rectal cancer: practical considerations[J]. Radiographics, 2012, 32(2):389-409.
[9]
Merkel S, Mansmann U, Siassi M, et al. The prognostic inhomogeneity in pT3 rectal carcinomas[J]. Int J Colorectal Dis, 2001, 16(5):298-304.
[10]
Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study[J]. Radiology, 2007, 243(1):132-139.
[11]
Feng Q, Yan YQ, Zhu J, et al. T staging of rectal cancer: accuracy of diffusion-weighted imaging compared with T2-weighted imaging on 3.0 tesla MRI[J]. J Dig Dis, 2014, 15(4):188-194.
[12]
Giusti S, Buccianti P, Castagna M, et al. Preoperative rectal cancer staging with phased-array MR[J]. Radiat Oncol, 2012, 7:29.
[13]
Halefoglu AM, Yildirim S, Avlanmis O, et al. Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer[J]. World J Gastroenterol, 2008, 14(22):3504-3510.
[14]
Brown G, Richards CJ, Bourne MW, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison[J]. Radiology, 2003, 227(2):371-377.
[15]
Yamada I, Yoshino N, Tetsumura A, et al. Colorectal Carcinoma: Local Tumor Staging and Assessment of Lymph Node Metastasis by High-Resolution MR Imaging in Surgical Specimens[J]. Int J Biomed Imaging, 2009, 2009:659836.
[16]
Koh DM, Brown G, Temple L, et al. Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings--initial observations[J]. Radiology, 2004, 231(1):91-99.
[17]
Smith N, Brown G. Preoperative staging of rectal cancer[J]. Acta Oncol, 2008, 47(1):20-31.
[18]
Lambregts DM, Beets GL, Maas M, et al. Accuracy of gadofosveset-enhanced MRI for nodal staging and restaging in rectal cancer[J]. Ann Surg, 2011, 253(3):539-545.
[19]
Gleeson FC, Clain JE, Rajan E, et al. EUS-FNA assessment of extramesenteric lymph node status in primary rectal cancer[J]. Gastrointest Endosc, 2011, 74(4):897-905.
[20]
Maleki Z, Erozan Y, Geddes S, et al. Endorectal ultrasound-guided fine-needle aspiration: a useful diagnostic tool for perirectal and intraluminal lesions[J]. Acta Cytol, 2013, 57(1):9-18.
[21]
Huang YQ, Liang CH, He L, et al. Development and Validation of a Radiomics Nomogram for Preoperative Prediction of Lymph Node Metastasis in Colorectal Cancer[J]. J Clin Oncol, 2016, 34(18):2157-2164.
[22]
Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer?[J]. J Clin Oncol, 2008, 26(2):303-312.
[23]
Baik SH, Kim NK, Lee YC, et al. Prognostic significance of circumferential resection margin following total mesorectal excision and adjuvant chemoradiotherapy in patients with rectal cancer[J]. Ann Surg Oncol, 2007, 14(2):462-469.
[24]
Frasson M, Garcia-Granero E, Roda D, et al. Preoperative chemoradiation may not always be needed for patients with T3 and T2N+ rectal cancer[J]. Cancer, 2011, 117(14):3118-3125.
[25]
Patel UB, Taylor F, Blomqvist L, et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience[J]. J Clin Oncol, 2011, 29(28):3753-3760.
[26]
Al-Sukhni E, Milot L, Fruitman M, et al. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis[J]. Ann Surg Oncol, 2012, 19(7):2212-2223.
[27]
Granero-Castro P, Munoz E, Frasson M, et al. Evaluation of mesorectal fascia in mid and low anterior rectal cancer using endorectal ultrasound is feasible and reliable: a comparison with MRI findings[J]. Dis Colon Rectum, 2014, 57(6):709-714.
[28]
Bhangu A, Fitzgerald JE, Slesser A, et al. Prognostic significance of extramural vascular invasion in T4 rectal cancer[J]. Colorectal Dis, 2013, 15(11):e665-671.
[29]
Smith NJ, Barbachano Y, Norman AR, et al. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer[J]. Br J Surg, 2008, 95(2):229-236.
[30]
Chand M, Swift RI, Tekkis PP, et al. Extramural venous invasion is a potential imaging predictive biomarker of neoadjuvant treatment in rectal cancer[J]. Br J Cancer, 2014, 110(1):19-25.
[31]
Minami Y, Kudo M. Radiofrequency ablation of liver metastases from colorectal cancer: a literature review[J]. Gut Liver, 2013, 7(1):1-6.
[32]
Steele G, Jr., Ravikumar TS. Resection of hepatic metastases from colorectal cancer. Biologic perspective[J]. Ann Surg, 1989, 210(2):127-138.
[33]
Kanas GP, Taylor A, Primrose JN, et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors[J]. Clin Epidemiol, 2012, 4:283-301.
[34]
Niekel MC, Bipat S, Stoker J. Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment[J]. Radiology, 2010, 257(3):674-684.
[35]
Tirumani SH, Kim KW, Nishino M, et al. Update on the role of imaging in management of metastatic colorectal cancer[J]. Radiographics, 2014, 34(7):1908-1928.
[36]
Koh DM, Collins DJ, Wallace T, et al. Combining diffusion-weighted MRI with Gd-EOB-DTPA-enhanced MRI improves the detection of colorectal liver metastases[J]. Br J Radiol, 2012, 85(1015):980-989.
[37]
Andre T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer[J]. N Engl J Med, 2004, 350(23):2343-2351.
[38]
Thirunavukarasu P, Sukumar S, Sathaiah M, et al. C-stage in colon cancer: implications of carcinoembryonic antigen biomarker in staging, prognosis, and management[J]. J Natl Cancer Inst, 2011, 103(8):689-697.
[39]
Sisik A, Kaya M, Bas G, et al. CEA and CA 19-9 are still valuable markers for the prognosis of colorectal and gastric cancer patients[J]. Asian Pac J Cancer Prev, 2013, 14(7):4289-4294.
[40]
Kim CW, Yoon YS, Park IJ, et al. Elevation of preoperative s-CEA concentration in stage IIA colorectal cancer can also be a high risk factor for stage II patients[J]. Ann Surg Oncol, 2013, 20(9):2914-2920.
[41]
Restivo A, Zorcolo L, Cocco IM, et al. Elevated CEA levels and low distance of the tumor from the anal verge are predictors of incomplete response to chemoradiation in patients with rectal cancer[J]. Ann Surg Oncol, 2013, 20(3):864-871.
[42]
Wallin U, Rothenberger D, Lowry A, et al. CEA - a predictor for pathologic complete response after neoadjuvant therapy for rectal cancer[J]. Dis Colon Rectum, 2013, 56(7):859-868.
[43]
Nicholson BD, Shinkins B, Mant D. Blood Measurement of Carcinoembryonic Antigen Level for Detecting Recurrence of Colorectal Cancer[J]. JAMA, 2016, 316(12):1310-1311.
[44]
Mavroudis D. Circulating cancer cells[J]. Ann Oncol, 2010, 21 Suppl 7:vii95-100.
[45]
Rahbari NN, Aigner M, Thorlund K, et al. Meta-analysis shows that detection of circulating tumor cells indicates poor prognosis in patients with colorectal cancer[J]. Gastroenterology, 2010, 138(5):1714-1726.
[46]
Huang X, Gao P, Song Y, et al. Relationship between circulating tumor cells and tumor response in colorectal cancer patients treated with chemotherapy: a meta-analysis[J]. BMC Cancer, 2014, 14:976.
[47]
Magni E, Botteri E, Ravenda PS, et al. Detection of circulating tumor cells in patients with locally advanced rectal cancer undergoing neoadjuvant therapy followed by curative surgery[J]. Int J Colorectal Dis, 2014, 29(9):1053-1059.
[48]
Gormally E, Caboux E, Vineis P, et al. Circulating free DNA in plasma or serum as biomarker of carcinogenesis: practical aspects and biological significance[J]. Mutat Res, 2007, 635(2-3):105-117.
[49]
Montagut C, Dalmases A, Bellosillo B, et al. Identification of a mutation in the extracellular domain of the Epidermal Growth Factor Receptor conferring cetuximab resistance in colorectal cancer[J]. Nat Med, 2012, 18(2):221-223.
[50]
Misale S, Yaeger R, Hobor S, et al. Emergence of KRAS mutations and acquired resistance to anti-EGFR therapy in colorectal cancer[J]. Nature, 2012, 486(7404):532-536.
[51]
Diaz LA, Jr., Williams RT, Wu J, et al. The molecular evolution of acquired resistance to targeted EGFR blockade in colorectal cancers[J]. Nature, 2012, 486(7404):537-540.
[52]
Hotker AM, Garcia-Aguilar J, Gollub MJ. Multiparametric MRI of rectal cancer in the assessment of response to therapy: a systematic review[J]. Dis Colon Rectum, 2014, 57(6):790-799.
[53]
Van der Paardt MP, Zagers MB, Beets-Tan RG, et al. Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis[J]. Radiology, 2013, 269(1):101-112.
[54]
Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data[J]. Lancet Oncol, 2010, 11(9):835-844.
[55]
Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results[J]. Ann Surg, 2004, 240(4):711-717; discussion 17-18.
[56]
Guillem JG, Ruby JA, Leibold T, et al. Neither FDG-PET Nor CT can distinguish between a pathological complete response and an incomplete response after neoadjuvant chemoradiation in locally advanced rectal cancer: a prospective study[J]. Ann Surg, 2013, 258(2):289-295.
[57]
Aiba T, Uehara K, Nihashi T, et al. MRI and FDG-PET for assessment of response to neoadjuvant chemotherapy in locally advanced rectal cancer[J]. Ann Surg Oncol, 2014, 21(6):1801-1808.
[58]
Shanmugan S, Arrangoiz R, Nitzkorski JR, et al. Predicting pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer using 18FDG-PET/CT[J]. Ann Surg Oncol, 2012, 19(7):2178-2185.
[59]
Gu J, Chen N. Current status of rectal cancer treatment in China[J]. Colorectal Dis, 2013, 15(11):1345-1350.
[60]
Tytherleigh MG, Mc CMNJ. Options for sphincter preservation in surgery for low rectal cancer[J]. Br J Surg, 2003, 90(8):922-933.
[61]
Nougaret S, Reinhold C, Mikhael HW, et al. The use of MR imaging in treatment planning for patients with rectal carcinoma: have you checked the "DISTANCE" ?[J]. Radiology, 2013, 268(2):330-344.
[62]
Gu J, Bo XF, Xiong CY, et al. Defining pelvic factors in sphincter-preservation of low rectal cancer with a three-dimensional digital model of pelvis[J]. Dis Colon Rectum, 2006, 49(10):1517-1526.
[63]
Bujko K, Rutkowski A, Chang GJ, et al. Is the 1-cm rule of distal bowel resection margin in rectal cancer based on clinical evidence?[J]. A systematic review. Ann Surg Oncol, 2012, 19(3):801-808.
[64]
Canda AE, Terzi C, Gorken IB, et al. Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients[J]. Int J Colorectal Dis, 2010, 25(2):197-204.
[65]
Pucciarelli S, Del Bianco P, Efficace F, et al. Patient-reported outcomes after neoadjuvant chemoradiotherapy for rectal cancer: a multicenter prospective observational study[J]. Ann Surg, 2011, 253(1):71-77.
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