切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2022, Vol. 11 ›› Issue (04) : 265 -271. doi: 10.3877/cma.j.issn.2095-3224.2022.04.001

所属专题: 指南共识

指南与共识

结直肠癌腹膜转移诊治中国专家共识(2022版)
中国医师协会结直肠肿瘤专业委员会腹膜肿瘤专委会   
  • 收稿日期:2022-06-01 出版日期:2022-08-25

Chinese expert consensus on the diagnosis and treatment of colorectal cancer peritoneal metastases (2022 edition)

Professional Committee of Peritoneal Metastasis, Colorectal Cancer Committee of Chinese Medical Doctor Association   

  • Received:2022-06-01 Published:2022-08-25
引用本文:

中国医师协会结直肠肿瘤专业委员会腹膜肿瘤专委会. 结直肠癌腹膜转移诊治中国专家共识(2022版)[J]. 中华结直肠疾病电子杂志, 2022, 11(04): 265-271.

Professional Committee of Peritoneal Metastasis, Colorectal Cancer Committee of Chinese Medical Doctor Association. Chinese expert consensus on the diagnosis and treatment of colorectal cancer peritoneal metastases (2022 edition)[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(04): 265-271.

我国结直肠癌发病率居恶性肿瘤第二位,死亡率居第四位,而腹膜作为其常见转移部位,发病率高,早期诊断困难,并且预后很差。由于目前结直肠癌腹膜转移的诊断及治疗尚未形成规范化的模式,2017年中国医师协会结直肠肿瘤专业委员会组织国内相关领域权威专家,制定《结直肠癌腹膜转移诊治中国专家意见(2017)》,在行业内起到了积极的作用。这几年,大家对结直肠癌腹膜转移的关注度越来越高,开展了一系列临床研究,积累了一些经验。因此,专委会特对2017版《结直肠癌腹膜转移诊治中国专家意见》进行修改,制定2022版《结直肠癌腹膜转移诊治中国专家共识》。以期指导和规范结直肠癌腹膜转移的诊断和治疗,制定合理有效的综合治疗方案,延长结直肠癌腹膜转移患者生存时间并改善生活质量,提高我国结直肠癌的整体诊治水平。

Colorectal cancer (CRC) has the second highest incidence and the fourth highest mortality rate among malignant tumors in China. Being common metastatic site, peritoneum metastases have high incidence, are difficult to diagnose early, and have a poor prognosis. Since the diagnosis and treatment of peritoneal metastases from colorectal cancer has not formed a standardized pattern, in 2017, the Colorectal Cancer Committee of the Chinese Medical Doctor Association organized relevant authoritative experts to formulate the Chinese expert opinion on the diagnosis and treatment of colorectal cancer peritoneal metastases(2017), which played a positive role within the profession.In the past few years, more and more attention has been paid to peritoneal metastases of colorectal cancer, and a series of clinical trials have been carried out and some experiences have been accumulated.Therefore, the committee has revised the 2017 edition of the Chinese expert opinion on the diagnosis and treatment of colorectal cancer peritoneal metastases and formulated the 2022 edition of the Chinese expert consensus on the diagnosis and treatment of colorectal cancer peritoneal metastases.In order to guide and standardize the diagnosis and treatment of colorectal cancer peritoneal metastases, develop a rational and effective comprehensive treatment option, prolong the survival time and improve the quality of life of patients, and improve the overall diagnosis and treatment level of colorectal cancer in China.

图1 腹膜癌指数分期系统14
表1 PSDSS评分标准
[1]
Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2]
Zheng RS, Zhang SW, Zeng HM, et al. Cancer incidence and mortality in China, 2016[J]. Journal of the National Cancer Center, 2022, 2: 1-9.
[3]
Franko J, Shi Q, Goldman CD, et al. Treatment of colorectal peritoneal carcinomatosis with systemic chemotherapy: a pooled analysis of north central cancer treatment group phase Ⅲ trials N9741 and N9841[J]. J Clin Oncol, 2012, 30(3): 263-267.
[4]
Yonemura Y, Bandou E, Kawamura T, et al. Quantitative prognostic indicators of peritoneal dissemination of gastric cancer[J]. Eur J Surg Oncol, 2006, 32(6): 602-606.
[5]
Fidler IJ. The pathogenesis of cancer metastasis: the 'seed and soil' hypothesis revisited[J]. Nat Rev Cancer, 2003, 3(6): 453-458.
[6]
Ahmed N, Riley C, Rice G, et al. Role of integrin receptors for fibronectin, collagen and laminin in the regulation of ovarian carcinoma functions in response to a matrix microenvironment[J]. Clin Exp Metastasis, 2005, 22(5): 391-402.
[7]
Suzuki HI, Kiyono K, Miyazono K. Regulation of autophagy by transforming growth factor-beta (TGF-beta) signaling[J]. Autophagy, 2010, 6(5): 645-647.
[8]
Al-Shammaa HA, Li Y, Yonemura Y. Current status and future strategies of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis[J]. World J Gastroenterol, 2008, 14(8): 1159-1166.
[9]
McMullen JRW, Selleck M, Wall NR, et al. Peritoneal carcinomatosis: limits of diagnosis and the case for liquid biopsy[J]. Oncotarget, 2017, 8(26): 43481-43490.
[10]
Baratti D, Kusamura S, Deraco M. The fifth international workshop on peritoneal surface malignancy (Milan, Italy, December 4-6, 2006): methodology of disease-specific consensus[J]. J Surg Oncol, 2008, 98(4): 258-262.
[11]
Esquivel J, Chua TC, Stojadinovic A, et al. Accuracy and clinical relevance of computed tomography scan interpretation of peritoneal cancer index in colorectal cancer peritoneal carcinomatosis: a multi-institutional study[J]. J Surg Oncol, 2010, 102(6): 565-570.
[12]
Dromain C, Leboulleux S, Auperin A, et al. Staging of peritoneal carcinomatosis: enhanced CT vs. PET/CT[J]. Abdom Imaging, 2008, 33(1):87-93.
[13]
李雁, 周云峰, 梁寒, 等. 细胞减灭术加腹腔热灌注化疗治疗腹膜表面肿瘤的专家共识[J]. 中国肿瘤临床, 2015, 42(4): 198-206.
[14]
Koh JL, Yan TD, Glenn D, et al. Evaluation of preoperative computed tomography in estimating peritoneal cancer index in colorectal peritoneal carcinomatosis[J]. Ann Surg Oncol, 2009, 16(2): 327-333.
[15]
Soussan M, Des Guetz G, Barrau V, et al. Comparison of FDG-PET/CT and MR with diffusion-weighted imaging for assessing peritoneal carcinomatosis from gastrointestinal malignancy[J]. Eur Radiol, 2012, 22(7): 1479-1487.
[16]
Yang XQ, Yan L, Chen C, et al. Application of C12 multi-tumor marker protein chip in the diagnosis of gastrointestinal cancer: results of 329 surgical patients and suggestions for improvement[J]. Hepatogastroenterology, 2009, 56(94-95): 1388-1394.
[17]
Yang XQ, Chen C, Peng CW, et al. Carbohydrate antigen 242 highly consists with carbohydrate antigen 19-9 in diagnosis and prognosis of colorectal cancer: study on 185 cases[J]. Med Oncol, 2012, 29(2): 1030-1036.
[18]
Chen C, Chen LQ, Yang GL, et al. The application of C12 biochip in the diagnosis and monitoring of colorectal cancer: systematic evaluation and suggestion for improvement[J]. J Postgrad Med, 2008, 54(3): 186-190.
[19]
Wagner PL, Austin F, Sathaiah M, et al. Significance of serum tumor marker levels in peritoneal carcinomatosis of appendiceal origin[J]. Ann Surg Oncol, 2013, 20(2): 506-514.
[20]
Fujita Y, Terashima M, Hoshino Y, et al. Detection of cancer cells disseminated in bone marrow using real-time quantitative RT-PCR of CEA, CK19, and CK20 mRNA in patients with gastric cancer[J]. Gastric Cancer, 2006, 9(4): 308-314.
[21]
Ozawa Y, Murakami M, Watanabe M, et al. Preoperative colonic cancer tattooing using the near-infrared fluorescence laparoscopic imaging system[J]. Asian J Endosc Surg, 2016, 9(4): 340-343.
[22]
Yonemura Y, Canbay E, Endou Y, et al. Peritoneal cancer treatment[J]. Expert Opin Pharmacother, 2014, 15(5): 623-636.
[23]
Akagi Y, Kinugasa T, Adachi Y, et al. Prognostic significance of isolated tumor cells in patients with colorectal cancer in recent 10-year studies[J]. Mol Clin Oncol, 2013, 1(4): 582-592.
[24]
Park EJ, Baik SH, Hur H, et al. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for appendiceal and colorectal cancer with peritoneal carcinomatosis: Clinical outcomes at 2 tertiary referral centers in Korea[J]. Medicine (Baltimore), 2017, 96(21): e6632.
[25]
Esquivel J, Lowy AM, Markman M, et al. The American society of peritoneal surface malignancies (ASPSM) multiinstitution evaluation of the peritoneal surface disease severity score (PSDSS) in 1,013 patients with colorectal cancer with peritoneal carcinomatosis[J]. Ann Surg Oncol, 2014, 21(13): 4195-4201.
[26]
孙立峰, 童舟, 丁克峰. 外科肿瘤细胞减灭术联合腹腔内热灌注化疗——结直肠癌腹膜转移治疗的突破方向?[J/CD]. 中华结直肠疾病电子杂志, 2015, 4(3): 234-239.
[27]
Gomez Portilla A, Cendoya I, Lopez de Tejada I, et al. Peritoneal carcinomatosis of colorectal origin. Current treatment. Review and update[J]. Rev Esp Enferm Dig, 2005, 97(10): 716-737.
[28]
Baratti D, Kusamura S, Azmi N, et al. Colorectal peritoneal metastases treated by perioperative systemic chemotherapy and cytoreductive surgery with or without mitomycin C-based HIPEC: acomparative study using the peritoneal surface disease severity score (PSDSS)[J]. Ann Surg Oncol, 2020, 27(1): 98-106.
[29]
Sugarbaker PH. Successful management of microscopic residual disease in large bowel cancer[J]. Cancer Chemother Pharmacol, 1999, (43 Suppl): S15-25.
[30]
Spratt JS, Adcock RA, Muskovin M, et al. Clinical delivery system for intraperitoneal hyperthermic chemotherapy[J]. Cancer Res, 1980, 40(2): 256-260.
[31]
Turaga K, Levine E, Barone R, et al. Consensus guidelines from the American society of peritoneal surface malignancies on standardizing the delivery of hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal cancer patients in the United States[J]. Ann Surg Oncol, 2014, 21(5): 1501-1505.
[32]
Moran BJ, Guerra GR. Randomized controlled trials in surgical resection of colorectal peritoneal metastases: Disentangling negativity in PRODIGE 7 and PROPHYLOCHIP[J]. Colorectal Dis, 2021, 23(6): 1303-1305.
[33]
Quenet F, Elias D, Roca L, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): a multicentre, randomised, open-label, phase 3 trial[J]. Lancet Oncol, 2021, 22(2): 256-266.
[34]
Mo S, Cai G. Multidisciplinary treatment for colorectal peritoneal metastases: review of the literature[J]. Gastroenterol Res Pract, 2016, 2016: 1516259.
[35]
Pages F, Andre T, Taieb J, et al. Prognostic and predictive value of the Immunoscore in stage III colon cancer patients treated with oxaliplatin in the prospective IDEA France PRODIGE-GERCOR cohort study[J]. Ann Oncol, 2020, 31(7): 921-929.
[36]
Maindrault-Goebel F, Louvet C, Andre T, et al. Oxaliplatin added to the simplified bimonthly leucovorin and 5-fluorouracil regimen as second-line therapy for metastatic colorectal cancer (FOLFOX6). GERCOR[J]. Eur J Cancer, 1999, 35(9): 1338-1342.
[37]
Peeters M, Price TJ, Cervantes A, et al. Randomized phase III study of panitumumab with fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as second-line treatment in patients with metastatic colorectal cancer[J]. J Clin Oncol, 2010, 28(31): 4706-4713.
[38]
Petrelli N, Herrera L, Rustum Y, et al. A prospective randomized trial of 5-fluorouracil versus 5-fluorouracil and high-dose leucovorin versus 5-fluorouracil and methotrexate in previously untreated patients with advanced colorectal carcinoma[J]. J Clin Oncol, 1987, 5(10): 1559-1565.
[39]
Tol J, Koopman M, Cats A, et al. Chemotherapy, bevacizumab, and cetuximab in metastatic colorectal cancer[J]. N Engl J Med, 2009, 360(6): 563-572.
[40]
NCCN Clinical Practice Guidelines in Oncology. Colon Cancer[EB/OL]. Version 1 2017.

URL    
[41]
Andre T, Amonkar M, Norquist JM, et al. Health-related quality of life in patients with microsatellite instability-high or mismatch repair deficient metastatic colorectal cancer treated with first-line pembrolizumab versus chemotherapy (KEYNOTE-177): an open-label, randomised, phase 3 trial[J]. Lancet Oncol, 2021, 22(5):665-677.
[42]
季加孚, 沈琳, 徐惠绵, 等. 胃癌腹膜转移防治中国专家共识[J]. 中国医学前沿杂志(电子版), 2017, 9(5): 29-40.
[43]
Kim JH, Ku YS, Jeon TJ, et al. The efficacy of self-expanding metal stents for malignant colorectal obstruction by noncolonic malignancy with peritoneal carcinomatosis[J]. Dis Colon Rectum, 2013, 56(11):1228-1232.
[44]
Kerscher AG, Chua TC, Gasser M, et al. Impact of peritoneal carcinomatosis in the disease history of colorectal cancer management: a longitudinal experience of 2406 patients over two decades[J]. Br J Cancer, 2013, 108(7):1432-1439.
[45]
Sadahiro S, Suzuki T, Maeda Y, et al. Prognostic factors in patients with synchronous peritoneal carcinomatosis (PC) caused by a primary cancer of the colon[J]. J Gastrointest Surg, 2009, 13(9):1593-1598.
[46]
Mulsow J, Merkel S, Agaimy A, et al. Outcomes following surgery for colorectal cancer with synchronous peritoneal metastases[J]. Br J Surg, 2011, 98(12):1785-1791.
[47]
Karoui M, Gallois C, Piessen G, et al. Does neoadjuvant FOLFOX chemotherapy improve the prognosis of high-risk Stage II and III colon cancers? Three years' follow-up results of the PRODIGE 22 phase II randomized multicentre trial[J]. Colorectal Dis, 2021, 23(6):1357-1369.
[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] 付佳, 肖海敏, 武曦, 冯涛, 师帅. 年龄校正查尔森合并症指数对腹腔镜结直肠癌围手术期并发症的预测价值[J]. 中华普通外科学文献(电子版), 2023, 17(05): 336-341.
[5] 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.
[6] 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.
[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] 常剑, 邱峰, 毛郁琪. 摄食抑制因子-1与腹腔镜结直肠癌根治术后肝转移的关系分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 502-505.
[9] 王晓燕, 肖佑, 肖戈, 王真权. 老年结直肠癌肺转移CT特征及高危因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 506-509.
[10] 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.
[11] 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.
[12] 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.
[13] 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.
[14] 孙昕, 程海波, 沈卫星. 基于全转录组学探讨仙连解毒方治疗Ⅲ期结直肠癌患者的疗效机制[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 277-283.
[15] 静脉淋巴功能不全临床专家共识编写组. 静脉淋巴功能不全临床专家共识[J]. 中华临床医师杂志(电子版), 2023, 17(06): 630-638.
阅读次数
全文


摘要