切换至 "中华医学电子期刊资源库"
高级检索
中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (02) : 188 -195. doi: 10.3877/cma.j.issn.2095-3224.2020.02.014

所属专题： 文献；

综述

进展期直肠癌新辅助放化疗研究进展
高倩闽1, 陈昕涛1, 姚厚山2, 胡志前2,†()   
  1. 1. 200433　第二军医大学基础医学院学员11队
    2. 200003　上海长征医院普外一科
  • 收稿日期:2019-07-17 出版日期:2020-04-25
  • 通信作者: 胡志前

Research progress in neoadjuvant chemoradiotherapy for advanced rectal cancer

Qianmin Gao1, Xintao Chen1, Houshan Yao2, Zhiqian Hu2,†()   

  1. 1. Team 11, Basic Medical College of the Second Military Medical University, Shanghai 200433, China
    2. Department of General Surgery, Changzheng Hospital, Shanghai 200003, China
  • Received:2019-07-17 Published:2020-04-25
  • Corresponding author: Zhiqian Hu
  • About author:
    Corresponding author: Hu Zhiqian, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

高倩闽, 陈昕涛, 姚厚山, 胡志前. 进展期直肠癌新辅助放化疗研究进展[J]. 中华结直肠疾病电子杂志, 2020, 09(02): 188-195.

Qianmin Gao, Xintao Chen, Houshan Yao, Zhiqian Hu. Research progress in neoadjuvant chemoradiotherapy for advanced rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(02): 188-195.

我国结直肠癌发病率和死亡率居高不下，直肠癌的发病率与术后局部复发率（LRR）通常高于结肠癌，且手术难度高。目前为了防止直肠癌的局部复发大多采取多学科方法医治。新辅助放化疗（nCRT）作为一种发展中的多学科方法，可提高治愈率又可维持器官功能，在直肠癌治疗中起着至关重要的作用。本综述旨在阐明nCRT的现状与未来的改进方向。

关键词: 直肠肿瘤, 进展期直肠癌, 新辅助化疗, 新辅助放疗, 新辅助放化疗, 局部复发率

The incidence and death rate of colorectal cancer are very high in China. The incidence and local recurrence rate of rectal cancer are usually higher than that of colon cancer. And the operation is difficult. At present, to prevent the local recurrence of rectal cancer, multidisciplinary treatment is widely used. Neoadjuvant chemoradiotherapy (nCRT), as a developing multidisciplinary method, can not only guarantee the curative effect but also maintain the organ function, and plays a crucial role in the treatment of rectal cancer. The purpose of this review is to clarify the current situation and future improvement direction of nCRT.

Key words: Rectal neoplasms, Advanced rectal cancer, Neoadjuvant chemotherapy, Neoadjuvant radiotherapy, Neoadjuvant chemoradiotherapy, Local recurrence rate
表1 "类三明治"新辅助治疗模式临床研究汇总
项目 XELOX＋Cap/RT＋XELOX XELOX＋XELOX/RT＋XELOX［27］ FOLFOX/Bev＋Bev/5-FU/RT＋FOLFOX［28］
完成新辅助治疗病例数 38 48 25
3~4级不良反应事件 ? ? ?
? 血液系统 10.5%（4/38） 12.2%（6/49） 72%（18/25）
? 非血液系统 13.2%（5/38） 18.4%（9/49） 48%（12/25）
pCR率 28.9%（11/38） 42.2%（19/45） 36%（9/25）
保肛率 52.6%（20/38） 73.3%（33/45） 80%（20/25）
术后并发症发生率 10.5%（4/38） 11.1%（5/45） 20%（5/25）
表2 新辅助治疗中添加奥沙利铂的临床试验
实验名称 实验年份 患者数量 试验方案 实验终点 中位随访时间（年） OS（%） DFS（%）
STAR-01［30］ 2011 379 5-FU OS，PCR - - -
368 5-FU＋OX ? ? - -
ACCORD 12［31,32］ 2012 299 Cape pCR >5 70.8 66.1
299 Cape＋OX ? ? 72.9（HR 0.90，P=0.5） 63.1（ HR 0.86，P=0.3）
CAO/ARO/AIO-04［33］ 2012，2015 623 5-FU DFS >3 88.0 71.2
613 5-FU＋OX ? ? 88.7（HR 0.96，CI 0.72~1.26） 75.3（HR 0.79，CI 0.64~0.98）
NSABP R-04［34］ 2014，2015 949 5-FU/Cape 手术失败行保肛手术 >3 79.0 64.2
659 5-FU/Cape＋OX ? ? 81.3（HR 0.89，P=0.38） 69.2（HR 0.91，P=0.34）
PETACC-6［35］ 2014，2018 623 Cape DFS >3 83.1 71.3
613 Cape＋OX ? ? 80.1（HR 1.17，P=0.25） 70.5（HR 1.02，P=0.84）
JIAO 2015［36］ 2015 103 Cape DFS，OS >3 86.4 70
103 Cape＋OX ? ? 90.3（P=0.5155） 80.6（P=0.076）
FOWARC［37］ 2016，2018 155→130 5-FU DFS >3 76.4±3.8 93.7±2.2
158→142 5-FU＋OX ? ? 77.8±3.5 92.0±2.3
实验名称 LRR（%） 转移率（%） pCR率（%） 3~4级毒性率（%） 保肛手术率（%） 奥沙利铂组术前化放疗依从性（%）
STAR-01［30］ 6.0 2.9（腹腔） 16.4 8.0（P<0.001） 80.6 -
1.3 0.5 16.8（P=0.904） 25.4 81.7 66.0
ACCORD 12［31,32］ 8.8 4.2（腹腔） 13.9（P<0.001） 10.9（P<0.001） - -
7.8（HR=0.92，P=0.7） 2.8 19.2 25.4 - 41.0
CAO/ARO/AIO-04［33］ 4.6 6.0 13.0 13.0 88.0 -
2.9 4.0（全部） 17.0（P =0.04） 17.0（P=0.04） 88.0 85.0
NSABP R-04［34］ 12.1 - 17.8 6.6 62.0 -
11.2（P=0.7） - 19.5（P=0.42） 15.4（P<0.0001） 62（ P =0.28） -
PETACC-6［35］ - - 11.3 15.2 70.0 -
- - 13.3 36.7 65.1（ P =0.09） -
JIAO 2015［36］ 5.8 28.2 23.3 6.8 77.7 -
4.9（ P =0.7） 16.5（P=0.045） 19.4（P=0.479） 16.5（P=0.03） 84.5 81.6
FOWARC［37］ 10.0 - 14.0 10.7 84.4 -
8.5 - 27.5（P=0.05） 21.3（P=0.037） 87.2 94.9
表3 直肠癌新辅助治疗中在奥沙利铂的基础上添加西妥昔单抗的临床试验
临床试验 患者数量 试验方案 试验终点 PFS（%）/中位PFS（月） OS（%）/中位OS（月） ORR（%） 3~4级毒性率（%）
SWOG 0713［38］ 75 wCAPOX＋C pCR 72% ? ? -
EXPERT-C［39］ 44 CAPOX＋C CR - ? 51 -
46 ? ? ? ? 71（P=0.38） ?
OPUS［40］ 170 FOLFOX4＋C pCR 8.3 22.8 57 -
168 FOLFOX4 ? 7.2（HR=0.567，P=0.0064） 18.5（HR=0.855，P=0.39） 34（P=0.0027） ?
COIN［41］ 815 mFOLFOX6/XELOX＋C OS 8.6 17 64 -
815 mFOLFOX6/XELOX ? 8.6（HR=0.96，P=0.60） 17.9（HR=1.04，P=0.67） 57（P=0.049） ?
NORDIC-7［42］ 498 Nordic FLOX＋C pCR 7.9 20.1 46 -
303 Nordic FLOX ? 8.7（HR=1.07，P=0.66） 22（HR=1.14，P=0.48） 47（P=0.89） ?
TAILOR［43］ 192 FOLFOX4＋C pCR 9.2 20.7 ? 16.2
200 FOLFOX4 ? 7.4（HR=0.69，P=0.004） 17.8（HR=0.76，P=0.02） ? 7.3
表4 直肠癌新辅助治疗中在奥沙利铂的基础上添加贝伐单抗的临床试验
临床试验 患者数量 试验方案 试验终点 中位随访时间（月） PFS（%）/中位PFS（月） OS（%）/中位OS（月） ORR（%）/中位ORR（月） 3~4级毒性率（%）
Wong R等［44］ 45 CAPOX＋Bev pCR 12.5 50% 86% 78% -
E3200［45］ 286 FOLFOX4＋Bev OS - 7.3 12.9 22.7% 61
291 FOLFOX4 ? ? 4.7（P<0.001） 10.8（P=0.011） 8.6%（P<0.001） 75
243 单独使用Bev ? ? 2.7（P<0.001） 10.2（P<0.001） 3.3%（P<0.001） 34
Saltz LB等［46］ 701 XELOX/FOLFOX4＋安慰剂 PFS - 8 19.9 7.4 75
699 XELOX/FOLFOX4＋Bev ? ? 9.4（P=0.0023） 21.3（P=0.0769） 8.45（P=0.0307） 80
表5 直肠癌新辅助治疗中在奥沙利铂的基础上添加伊立替康的临床试验
临床试验 患者数量 试验方案 试验终点 pCR率（%） ORR（%） 3~4级毒性率（%）
RTOGT0012［48］ 52 CVI pCR - 29 42
54 CVI＋I ? ? 31 51
ROTOG0247［49］ 55 MF＋I pCR 10 - 42
56 MF＋OX ? 21 ? 51
[1]
陈万青, 孙可欣, 郑荣寿,等. 2014年中国分地区恶性肿瘤发病和死亡分析 [J]. 中国肿瘤, 2018, 27(1): 1-14.
[2]
杜灵彬, 李辉章, 郑荣寿,等. 2013年中国结直肠癌发病与死亡分析 [J]. 中华肿瘤杂志, 2017, 39(9): 701-706.
[3]
Gunderson LL, Jessup JM, Sargent DJ, et al. Revised tumor and node categorization for rectal cancer based on surveillance, epidemiology, and end results and rectal pooled analysis outcomes [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2010, 28(2): 256-263.
[4]
Bruheim K, Guren MG, Skovlund E, et al. Late side effects and quality of life after radiotherapy for rectal cancer [J]. Int J Radiat Oncol Biol Phys, 2010, 76(4): 1005-1011.
[5]
Birgisson H, Påhlman L, Gunnarsson U, et al. Late adverse effects of radiation therapy for rectal cancer-a systematic overview [J]. Acta Oncol Stockh Swed, 2007, 46(4): 504-516.
[6]
Kye BH, Cho HM. Overview of radiation therapy for treating rectal cancer [J]. Ann Coloproctology, 2014, 30(4): 165-174.
[7]
Benson AB, Venook AP, Al-Hawary MM, et al. Rectal cancer, version 2. 2018, NCCN clinical practice guidelines in oncology [J]. J Natl Compr Cancer Netw, 2018, 16(7): 874-901.
[8]
Ceelen WP, Van Nieuwenhove Y, Fierens K. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer [J]. Cochrane Database Syst Rev, 2009(1): CD006041.
[9]
Bosset JF, Calais G, Mineur L, et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results--EORTC 22921 [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2005, 23(24): 5620-5627.
[10]
McCarthy K, Pearson K, Fulton R, et al. Pre-operative chemoradiation for non-metastatic locally advanced rectal cancer [J]. Cochrane Database Syst Rev, 2012, 12: CD008368.
[11]
Bonnetain F, Bosset JF, Gerard JP, et al. What is the clinical benefit of preoperative chemoradiotherapy with 5FU/leucovorin for T3-4 rectal cancer in a pooled analysis of EORTC 22921 and FFCD 9203 trials: surrogacy in question? [J]. Eur J Cancer Oxf Engl, 2012, 48(12): 1781-1790.
[12]
Sauer R, Liersch T, Merkel S, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2012, 30(16): 1926-1933.
[13]
中华人民共和国卫生和计划生育委员会医政医管局. 中国结直肠癌诊疗规范(2015版) [J]. 中华消化外科杂志, 2015, 14(10): 783-799.
[14]
Pham TT, Stait-Gardner T, Lee CS, et al. Correlation of ultra-high field MRI with histopathology for evaluation of rectal cancer heterogeneity [J]. Sci Rep, 2019, 9(1): 9311.
[15]
Chen CC, Lai YL, Jiang JK, et al. Transanal total mesorectal excision versus laparoscopic surgery for rectal cancer receiving neoadjuvant chemoradiation: A matched case-control study [J]. Ann Surg Oncol, 2016, 23(4): 1169-1176.
[16]
Patel UB, Blomqvist LK, Taylor F, et al. MRI after treatment of locally advanced rectal cancer: how to report tumor response--the MERCURY experience [J]. AJR. American Journal of Roentgenology, 2012, 199(4): W486-495.
[17]
Sclafani F, Brown G, Cunningham D, et al. Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer [J]. Br J Cancer, 2017, 117(10): 1478-1485.
[18]
Francois Y, Nemoz CJ, Baulieux J, et al. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial [J]. J Clin Oncol Off J Am Soc Clin Oncol, 1999, 17(8): 2396.
[19]
Du D, Su Z, Wang D, et al. Optimal interval to surgery after neoadjuvant chemoradiotherapy in rectal cancer: A aystematic review and Meta-analysis [J]. Clin Colorectal Cancer, 2018, 17(1): 13-24.
[20]
Sloothaak DA. Geijsen DE, van Leersum N J, et al. Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer [J]. Br J Surg, 2013, 100(7): 933-939.
[21]
Pham TT, Stait-Gardner T, Lee CS, et al. Correlation of ultra-high field MRI with histopathology for evaluation of rectal cancer heterogeneity [J]. Sci Rep, 2019, 9(1): 9311.
[22]
Fernandez-Martos C, Garcia-Albeniz X, Pericay C, et al. Chemoradiation, surgery and adjuvant chemotherapy versus induction chemotherapy followed by chemoradiation and surgery: long-term results of the Spanish GCR-3 phase II randomized trial [J]. Ann Oncol Off J Eur Soc Med Oncol, 2015, 26(8): 1722-1728.
[23]
Cercek A, Goodman KA, Hajj C, et al. Neoadjuvant chemotherapy first, followed by chemoradiation and then surgery, in the management of locally advanced rectal cancer [J]. J Natl Compr Cancer Netw JNCCN, 2014, 12(4): 513-519.
[24]
Fernández-Martos C, Pericay C, Aparicio J, et al. Phase II, randomized study of concomitant chemoradiotherapy followed by surgery and adjuvant capecitabine plus oxaliplatin (CAPOX) compared with induction CAPOX followed by concomitant chemoradiotherapy and surgery in magnetic resonance imaging-defined, locally advanced rectal cancer: Grupo cancer de recto 3 study [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2010, 28(5): 859-865.
[25]
Garcia-Aguilar J, Chow OS, Smith DD, et al. Timing of rectal cancer response to chemoradiation consortium. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial [J]. Lancet Oncol,2015, 16(8): 957-966.
[26]
Zhu J, Liu F, Gu W, et al. Concomitant boost IMRT-based neoadjuvant chemoradiotherapy for clinical stageⅡ/Ⅲ rectal adenocarcinoma: results of a phase Ⅱ study [J]. Radiat Oncol Lond Engl, 2014, 9: 70.
[27]
Gao YH, Lin JZ, An X, et al. Neoadjuvant sandwich treatment with oxaliplatin and capecitabine administered prior to, concurrently with, and following radiation therapy in locally advanced rectal cancer: a prospective phase 2 trial [J]. Int J Radiat Oncol Biol Phys, 2014, 90(5): 1153-1160.
[28]
Xiao J, Chen Z, Li W, et al. Sandwich-like neoadjuvant therapy with bevacizumab for locally advanced rectal cancer: a phase II trial [J]. Cancer Chemother Pharmacol, 2015, 76(1): 21-27.
[29]
Rawla P, Barsouk A, Hadjinicolaou AV, et al. Immunotherapies and targeted therapies in the treatment of metastatic colorectal cancer [J]. Med Sci Basel Switz, 2019, 7: 83.
[30]
Aschele C, Cionini L, Lonardi S, et al. Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2011, 29(20): 2773-2780.
[31]
Gérard JP, Azria D, Gourgou-Bourgade S, et al. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2 [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2010, 28(10): 1638-1644.
[32]
Azria D, Doyen J, Jarlier M, et al. Late toxicities and clinical outcome at 5 years of the ACCORD 12/0405-PRODIGE 02 trial comparing two neoadjuvant chemoradiotherapy regimens for intermediate-risk rectal cancer [J]. Ann Oncol Off J Eur Soc Med Oncol, 2017, 28(10): 2436-2442.
[33]
Rödel C, Graeven U, Fietkau R, et al. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial [J]. Lancet Oncology, 2015, 16(8): 979-989.
[34]
O′Connell MJ, Colangelo LH, Beart RW, et al. Capecitabine and oxaliplatin in the preoperative multimodality treatment of rectal cancer: surgical end points from National Surgical Adjuvant Breast and Bowel Project trial R-04 [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2014, 32(18): 1927-1934.
[35]
Gormly KL, Coscia C, Wells T, et al. MRI rectal cancer in Australia and New Zealand: An audit from the PETACC-6 trial [J]. J Med Imaging Radiat Oncol, 2016, 60(5): 607-615.
[36]
Jiao D, Zhang R, Gong Z, et al. Fluorouracil-based preoperative chemoradiotherapy with or without oxaliplatin for stage II/III rectal cancer: a 3-year follow-up study [J]. Chin J Cancer Res Chung-Kuo Yen Cheng Yen Chiu, 2015, 27(6): 588-596.
[37]
Deng Y, Chi P, Lan P, et al. Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: initial results of the Chinese FOWARC multicenter, open-label, randomized three-arm phase III Trial [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2016, 34(27): 3300-3307.
[38]
Leichman CG, McDonough SL, Smalley SR, et al. Cetuximab combined with induction oxaliplatin and capecitabine, followed by neoadjuvant chemoradiation for locally advanced rectal cancer: SWOG 0713 [J]. Clinical colorectal cancer, 2018, 17(1): e121-e125.
[39]
Dewdney A, Cunningham D, Tabernero J, et al. Multicenter randomized phase II clinical trial comparing neoadjuvant oxaliplatin, capecitabine, and preoperative radiotherapy with or without cetuximab followed by total mesorectal excision in patients with high-risk rectal cancer (EXPERT-C) [J]. J Clin Oncol, 2012, 30(14): 1620-1627.
[40]
Bokemeyer C, Bondarenko I, Hartmann J T, et al. Efficacy according to biomarker status of cetuximab plus FOLFOX-4 as first-line treatment for metastatic colorectal cancer: the OPUS study [J]. Ann Oncol Off J Eur Soc Med Oncol, 2011, 22(7): 1535-1546.
[41]
Maughan TS, Adams RA, Smith CG, et al. Addition of cetuximab to oxaliplatin-based first-line combination chemotherapy for treatment of advanced colorectal cancer: results of the randomised phase 3 MRC COIN trial [J]. Lancet, 2011, 377(9783): 2103-2114.
[42]
Tveit KM, Guren T, Glimelius B, et al. Phase III trial of cetuximab with continuous or intermittent fluorouracil, leucovorin, and oxaliplatin (Nordic FLOX) versus FLOX alone in first-line treatment of metastatic colorectal cancer: the NORDIC-VII study [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2012, 30(15): 1755-1762.
[43]
Qin S, Li J, Wang L, et al. Efficacy and tolerability of first-line cetuximab plus leucovorin, fluorouracil, and oxaliplatin (FOLFOX-4) versus FOLFOX-4 in patients with RAS wild-type metastatic colorectal cancer: The open-label, randomized, phase III TAILOR trial [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2018, 36(30): 3031-3039.
[44]
Wong R, Cunningham D, Barbachano Y, et al. A multicentre study of capecitabine, oxaliplatin plus bevacizumab as perioperative treatment of patients with poor-risk colorectal liver-only metastases not selected for upfront resection [J]. Ann Oncol Off J Eur Soc Med Oncol, 2011, 22(9): 2042-2048.
[45]
Giantonio BJ, Catalano PJ, Meropol NJ, et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200 [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2007, 25(12): 1539-1544.
[46]
Saltz LB, Clarke S, Díaz-Rubio E, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2008, 26(12): 2013-2019.
[47]
Blazer DG, Kishi Y, Maru DM, et al. Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2008, 26(33): 5344-5351.
[48]
Mohiuddin M, Winter K, Mitchell E, et al. Randomized phase II study of neoadjuvant combined-modality chemoradiation for distal rectal cancer: Radiation Therapy Oncology Group Trial 0012 [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2006, 24(4): 650-655.
[49]
Wong SJ, Winter K, Meropol NJ, et al. Radiation Therapy Oncology Group 0247: a randomized Phase II study of neoadjuvant capecitabine and irinotecan or capecitabine and oxaliplatin with concurrent radiotherapy for patients with locally advanced rectal cancer [J]. Int J Radiat Oncol Biol Phys, 2012, 82(4): 1367-1375.
[50]
Du D, Su Z, Wang D, et al. Optimal interval to surgery after neoadjuvant chemoradiotherapy in rectal cancer: A systematic review and Meta-analysis [J]. Clinical Colorectal Cancer, 2018, 17(1): 13-24.
[51]
Gérard JP, Azria D, Gourgou-Bourgade S, et al. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2 [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2010, 28(10): 1638-1644.
[52]
Gérard JP, Azria D, Gourgou-Bourgade S, et al. Clinical outcome of the ACCORD 12/0405 PRODIGE 2 randomized trial in rectal cancer [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2012, 30(36): 4558-4565.
[53]
Aschele C, Cionini L, Lonardi S, et al. Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial [J]. J Clin Oncol Off J Am Soc Clin Oncol, 2011, 29(20): 2773-2780.
[54]
Yamashita K, Matsuda T, Hasegawa H, et al. Recent advances of neoadjuvant chemoradiotherapy in rectal cancer: Future treatment perspectives [J]. Annals Gastroenterol Surg, 2019, 3(1): 24-33.
[1] 康夏, 田浩, 钱进, 高源, 缪洪明, 齐晓伟. 骨织素抑制破骨细胞分化改善肿瘤骨转移中骨溶解的机制研究[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 329-339.
[2] 代莉, 邓恢伟, 郭华静, 黄芙蓉. 术中持续输注艾司氯胺酮对腹腔镜结直肠癌手术患者术后睡眠质量的影响[J]. 中华普通外科学文献(电子版), 2023, 17(06): 408-412.
[3] 王得晨, 杨康, 杨自杰, 归明彬, 屈莲平, 张小凤, 高峰. 结直肠癌微卫星稳定状态和程序性死亡、吲哚胺2,3-双加氧酶关系的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(06): 462-465.
[4] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[5] 张生军, 赵阿静, 李守博, 郝祥宏, 刘敏丽. 高糖通过HGF/c-met通路促进结直肠癌侵袭和迁移的实验研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 21-24.
[6] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[7] 李婷, 张琳. 血清脂肪酸代谢物及维生素D水平与结直肠癌发生的关系研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 661-665.
[8] 付振保, 曹万龙, 刘富红. 腹腔镜直肠癌低位前切除术中不同缝合方法的回肠双腔造口术临床效果研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 684-687.
[9] 贺亮, 王松林, 周业江. 两种预防性回肠造口在腹腔镜ISR术治疗超低位直肠癌的效果对比研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 697-700.
[10] 关旭, 王锡山. 基于外科与免疫视角思考结直肠癌区域淋巴结处理的功与过[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 448-452.
[11] 顾睿祈, 方洪生, 蔡国响. 循环肿瘤DNA检测在结直肠癌诊治中的应用与进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 453-459.
[12] 卢艳军, 马健, 白鹏宇, 郭凌宏, 刘海义, 江波, 白文启, 张毅勋. 纳米碳在腹腔镜直肠癌根治术中253组淋巴结清扫的临床效果[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 473-477.
[13] 倪文凯, 齐翀, 许小丹, 周燮程, 殷庆章, 蔡元坤. 结直肠癌患者术后发生延迟性肠麻痹的影响因素分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 484-489.
[14] 范小彧, 孙司正, 鄂一民, 喻春钊. 梗阻性左半结肠癌不同手术治疗方案的选择应用[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 500-504.
[15] 杨红杰, 张智春, 孙轶. 直肠癌淋巴结转移诊断研究进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 512-518.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号