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中华结直肠疾病电子杂志 ›› 2022, Vol. 11 ›› Issue (06) : 516 -520. doi: 10.3877/cma.j.issn.2095-3224.2022.06.011

所属专题: 经典病例

病例报道

多学科诊治不可切除结肠癌肝转移病例报道并文献复习
劳烨芳1, 何芮1, 朱芮1, 张晓辉1, 朱春荣1,()   
  1. 1. 215006 苏州大学附属第一医院肿瘤科
  • 收稿日期:2022-09-22 出版日期:2022-12-25
  • 通信作者: 朱春荣
  • 基金资助:
    横向项目(Z080001)

Multidisciplinary diagnosis and treatment of liver metastases from unresectable colon cancer: a case report and literature review

Yefang Lao1, Rui He1, Rui Zhu1, Xiaohui Zhang1, Chunrong Zhu1()   

  1. 1. Department of Oncology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
  • Received:2022-09-22 Published:2022-12-25
  • Corresponding author: Chunrong Zhu
引用本文:

劳烨芳, 何芮, 朱芮, 张晓辉, 朱春荣. 多学科诊治不可切除结肠癌肝转移病例报道并文献复习[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(06): 516-520.

Yefang Lao, Rui He, Rui Zhu, Xiaohui Zhang, Chunrong Zhu. Multidisciplinary diagnosis and treatment of liver metastases from unresectable colon cancer: a case report and literature review[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(06): 516-520.

近年来,不论是早期还是进展期结直肠癌的诊疗手段都呈现日新月异的进展,尤其是多学科综合治疗理念的逐步完善,显著延长了结直肠癌患者的总生存期(OS)及无进展生存期(PFS),本例报道分享一例左右肝多发转移的初始不可切除结肠癌病例,在多学科团队(MDT)的全程管理、个体化治疗下通过转化治疗及根治性手术后患者最终达到病理完全缓解(pCR),无瘤生存。

In recent years, diagnosis and treatment methods of colorectal cancer, including early and advanced stage, are rapidly progressing in each passing day. In particular, the gradual improvement of the concept of multidisciplinary comprehensive treatment significantly prolongs the OS and PFS of colorectal cancer patients. This report shares a case of an initial unresectable colon cancer with multiple hepatic metastases, who achieved tumor-free survival by pCR through translational therapy and radical surgery under the whole-course management and individualized treatment of MDT.

图1 患者初诊时以及手术前平扫+增强腹部CT表现对比。1A、1C:为患者初诊时CT表现,可见左右肝广泛转移;1B、1D为患者术前CT表现,可见右肝转移灶明显缩小,左肝转移灶消失,箭头所指为病灶
图2 为患者术前肝脏普美显MRI表现,箭头所指为病灶
图3 为患者术前肠镜病理,间质见少量异型腺体(HE染色,放大倍数4×10)
图4 术后病理。4A:结肠,4B:肝脏,均未见肿瘤细胞(HE染色,放大倍数4×10)
图5 患者初诊至末次随访期间肿瘤指标变化趋势
[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]
Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022 [J]. CA Cancer J Clin, 2022, 72(1): 7-33.
[3]
Primrose JN. Surgery for colorectal liver metastases [J]. Br J Cancer, 2010, 102(9): 1313-1318.
[4]
Haraldsdottir S, Wu C, Bloomston M, et al. What is the optimal neo-adjuvant treatment for liver metastasis? [J]. Ther Adv Med Oncol, 2013, 5(4): 221-234.
[5]
Tejpar S, Stintzing S, Ciardiello F, et al. Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer: retrospective analyses of the CRYSTAL and FIRE-3 trials[J]. JAMA Oncol, 2017, 3(2): 194-201.
[6]
卢婧, 孙祺, 车向明. 潜在可切除的结直肠癌同时性肝转移的治疗策略[J]. 现代肿瘤医学, 2021, 29(18): 3317-3320.
[7]
Andre T, Shiu KK, Kim TW, et al. Pembrolizumab in microsatellite-instability-high advanced colorectal cancer [J]. N Engl J Med, 2020, 383(23): 2207-2218.
[8]
Chalabi M, Fanchi LF, Dijkstra KK, et al. Neoadjuvant immunotherapy leads to pathological responses in MMR-proficient and MMR-deficient early-stage colon cancers [J]. Nat Med, 2020, 26(4): 566-576.
[9]
Molla M, Fernandez-Plana J, Albiol S, et al. Limited liver or lung colorectal cancer metastases. systemic treatment, surgery, ablation or SBRT[J]. J Clin Med, 2021, 10(10): 2131.
[10]
Kambakamba P, Hoti E, Cremen S, et al. The evolution of surgery for colorectal liver metastases: A persistent challenge to improve survival [J]. Surgery, 2021, 170(6):1732-1740.
[11]
张炜力, 周驰, 邓宇翔, 等. 初始不可切除结直肠癌肝转移转化治疗结局影响因素分析[J]. 中华胃肠外科杂志, 2022, 25(1): 56-62.
[12]
张钰洋, 陈善稳, 王鹏远, 等. 结直肠癌肝转移转化治疗的研究进展[J]. 中华胃肠外科杂志, 2021, 24(1): 85-93.
[13]
Smith JJ, Strombom P, Chow OS, et al. Assessment of a watch-and-wait strategy for rectal cancer in patients with a complete response after neoadjuvant therapy [J]. JAMA Oncol, 2019, 5(4): e185896.
[14]
Fernandez LM, São Julião GP, Figueiredo NL, et al. Conditional recurrence-free survival of clinical complete responders managed by watch and wait after neoadjuvant chemoradiotherapy for rectal cancer in the International Watch & Wait Database: a retrospective, international, multicentre registry study [J]. The Lancet Oncology, 2021, 22(1): 43-50.
[15]
López-campos F, Martín-martín M, Fornell-pérez R, et al. Watch and wait approach in rectal cancer: Current controversies and future directions[J]. World J Gastroenterol, 2020, 26(29): 4218-4239.
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