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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 (06) : 605 -609. doi: 10.3877/cma.j.issn.2095-3224.2020.06.012

所属专题： 总编推荐； 文献；

综述

结直肠癌骨转移的研究现状及治疗
马晨曦1, 关旭1, 王锡山1,†()   
  1. 1. 100021　北京，国家癌症中心／国家肿瘤临床医学研究中心／中国医学科学院北京协和医学院肿瘤医院结直肠外科
  • 收稿日期:2020-04-22 出版日期:2020-12-25
  • 通信作者: 王锡山
  • 基金资助:
    中国医学科学院医学与健康科技创新工程项目(No. 2016-I2M-1-001); 北京市科技计划(No. D171100002617004)

The current research status and treatment of bone metastasis from colorectal cancer

Chenxi Ma1, Xu Guan1, Xishan Wang1,†()   

  1. 1. Department of Colorectal Surgery, National Cancer Center /National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Received:2020-04-22 Published:2020-12-25
  • Corresponding author: Xishan Wang
  • About author:
    Corresponding author: Wang Xishan, Email:
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马晨曦, 关旭, 王锡山. 结直肠癌骨转移的研究现状及治疗[J]. 中华结直肠疾病电子杂志, 2020, 09(06): 605-609.

Chenxi Ma, Xu Guan, Xishan Wang. The current research status and treatment of bone metastasis from colorectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(06): 605-609.

结直肠癌是我国最常见的恶性肿瘤之一。结直肠癌骨转移临床较为少见，通常合并其他部位远处转移，但其发病率近年来逐渐上升。发生骨转移的结直肠癌患者因已处于病程晚期，且可能出现剧烈骨痛等骨转移事件，多预后不良。结直肠癌骨转移最常见于脊椎，其次为骨盆，其确诊主要依靠影像学检查。国内外开展了多项研究来探索影响结直肠癌骨转移的危险因素和预后因素，以更好地指导临床医生早期诊断和治疗。虽然目前缺乏标准的临床诊疗指南，但随着医学的进步，人们对于晚期骨转移的治疗也有了新的认识。本文通过总结国内外相关文献，介绍结直肠癌骨转移的研究现状及治疗方式。

关键词: 结直肠肿瘤, 骨转移, 流行病学, 诊断, 治疗

Colorectal cancer is one of most common malignant tumors in China. Bone metastasis (BM) from colorectal cancer is rare in clinic, which is usually accompanied with distant metastases of other sites. However, its incidence has gradually increased in recent years. Most of colorectal cancer patients with BM have a poor prognosis due to the advanced stage and skeletal-related events (SREs) such as severe bone pain. The most common site of BM from colorectal cancer is spine, followed by pelvis and its diagnosis mainly depends on imaging examination. A number of studies have been carried out at home and abroad to explore the risk factors and prognostic factors of BM from CRC. Although there are no standardized clinical guidelines, more knowledge on the treatment strategies for bone metastasis has been acquired with the development of medical science. This paper summarized the domestic and foreign literature to introduce the current research status and treatment of BM from CRC.

Key words: Colorectal neoplasms, Bone metastasis, Epidemiology, Diagnosis, Treatment
表1 不同影像学方法诊断骨转移瘤的优势与劣势[20,30,31,32,33,34,35]
影像学方法 优势 劣势
X线 1.特异性高：可诊断骨关节病等骨病，便于排除骨良性病变
2.定性诊断：骨转移瘤在X线片上可表现为溶骨型、成骨型及混合型[20]
3.经济方便		 1.诊断滞后性：骨质破坏30%~50%显示异常[30]
2.敏感度低：骨转移瘤检出率约60%
CT 1.显示清晰：可明确骨质破坏范围、破坏区有无肿瘤组织形成以及肿瘤对周围组织的侵犯程度等
2.有助于压缩性骨折的定性诊断[33]		 诊断滞后性：反映骨皮质破坏情况较X线敏感，但仍需到一定程度才能显示异常[30]
99Tcm骨显像 1.早期诊断：骨质破坏达5%显示异常
2.敏感度高：骨转移瘤检出率达94%
3.全身成像：可发现不同部位多发病灶，更准确反映骨转移灶数目		 1.特异性差：难以鉴别骨关节病、骨折、骨髓炎和Paget病等伴有双膦酸盐沉积的良性病
2.解剖图像不佳
MRI 1.早期诊断：比CT及骨扫描可更早探测到骨转移病灶[33]
2.定位诊断准确：可明确骨髓破坏程度、髓腔内原发灶与转移灶、侵犯范围、受累血管情况等[30]
3.无放射性损伤		 难以鉴别血管瘤、炎症性反应等良性病[30]
18F-FDG PET/PET-CT 1.早期诊断：可在骨转移侵犯骨髓而未累及骨皮质时发现病灶，优于CT和骨扫描[30]
2.敏感度高：检测率高于其他影像学方法，可达90%以上[31,32,34]
3.评估全面：可同时检测原发肿瘤位置、淋巴结状态及远处转移[35]		 1.易受近期放化疗的影响
2.费用较高
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