结直肠癌肝转移新辅助治疗研究进展

doi:10.3877/cma.j.issn.2095-3224.2018.04.012

结直肠癌的发病率及死亡率在全世界范围内逐年上升，其主要的死亡原因是肝转移。现代医学技术快速发展推动了诊治理念不断更新。个体化治疗及多学科综合治疗协作组（MDT）诊治理念的提出，外科技术以及局部治疗的迅速发展，使患者的生存期得以明显延长。结直肠癌肝转移新辅助治疗的应用有助于降低肿瘤分期，提高手术切除率，进而转化为患者生存获益，这一点在其他实体瘤中也已得到证实。但新辅助治疗是否延长所有患者生存期以及患者能否从局部治疗中获益仍存在争议，本文就结直肠癌肝转移新辅助治疗研究进展进行综述。

关键词: 结直肠肿瘤, 肿瘤转移, 新辅助治疗, 结直肠癌肝转移, 全身治疗, 局部治疗, 生存期

The incidence and mortality rates of colorectal cancer are continually increasing worldwide. The main cause of death is liver metastasis. Rapid development of modern medical technology contribute to the update of diagnosis concept and treatment. With the ideas of personalized treatment and multidisciplinary team are put forward and rapid development of surgical skill and local treatment, the over survival time has been extended significantly. The application of colorectal liver metastases neoadjuvant therapy helps to reduce the tumor stage, improve the resection rate, and then benefit the patient. This has also been confirmed in other solid tumors. But whether neoadjuvant therapy can improve overall survival or all patients could benefit from local treatment is still controversial. The research progress on colorectal cancer liver metastasis neoadjuvant therapy is reviewed in this paper.

Key words: Colorectal neoplasms, Neoplasm metastasis, Neoadjuvant therapy, Colorectal liver metastases, Systemic therapy, Local treatment, Overall survival

表1 可切除CRLM患者新辅助化疗疗效相关临床研究

相关研究	年限	治疗方法（n）	3-y OS（%）	5-y OS（%）
Araujo^[10]	2013	NEO（n=175）	74.0	56.0
		SG（n=236）	78.0	60.0
Booney^[11]	2015	NEO（n=693）	72.0	N/A
		SG（n=608）	74.0
Oh^[12]	2013	NEO（n=15）	44.0	N/A
		SG（n=15）	55.7
Pinto^[13]	2012	NEO（n=334）	59.0	43.0
		SG（n=342）	71.0	55.0

表1 可切除CRLM患者新辅助化疗疗效相关临床研究

相关研究	年限	治疗方法（n）	3-y OS（%）	5-y OS（%）
Araujo^[10]	2013	NEO（n=175）	74.0	56.0
		SG（n=236）	78.0	60.0
Booney^[11]	2015	NEO（n=693）	72.0	N/A
		SG（n=608）	74.0
Oh^[12]	2013	NEO（n=15）	44.0	N/A
		SG（n=15）	55.7
Pinto^[13]	2012	NEO（n=334）	59.0	43.0
		SG（n=342）	71.0	55.0

表2 新辅助化疗联合西妥西单抗疗效的相关临床研究

研究	患者人群	数量	治疗组/对照组	R0切除率
Ye^[17]	KRAS-w最初不可切除	138	西妥西单抗联合化疗/单纯化疗	25.7% vs 7.4%
Xu^[18]	KRAS-w最初不可切除	93	西妥西单抗联合化疗/单纯化疗	26.7% vs 6.3%
Uetake^[19]	KRAS-w最初不可切除	45	贝伐珠单抗联合化疗	44.4%
Cui^[20]	CRLM	535	贝伐珠单抗联合化疗	49.2%
Garcia^[21]	可切除CRLM	20	贝伐珠单抗联合化疗	90%
Gruenerger^[22]	可切除CRLM	45	贝伐珠单抗联合化疗	97%

表2 新辅助化疗联合西妥西单抗疗效的相关临床研究

研究	患者人群	数量	治疗组/对照组	R0切除率
Ye^[17]	KRAS-w最初不可切除	138	西妥西单抗联合化疗/单纯化疗	25.7% vs 7.4%
Xu^[18]	KRAS-w最初不可切除	93	西妥西单抗联合化疗/单纯化疗	26.7% vs 6.3%
Uetake^[19]	KRAS-w最初不可切除	45	贝伐珠单抗联合化疗	44.4%
Cui^[20]	CRLM	535	贝伐珠单抗联合化疗	49.2%
Garcia^[21]	可切除CRLM	20	贝伐珠单抗联合化疗	90%
Gruenerger^[22]	可切除CRLM	45	贝伐珠单抗联合化疗	97%

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Progress in neoadjuvant therapy of colorectal cancer liver metastasis

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Progress in neoadjuvant therapy of colorectal cancer liver metastasis