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 ›› 2023, Vol. 12 ›› Issue (04) : 337 -341. doi: 10.3877/cma.j.issn.2095-3224.2023.04.011

综述

初始不可切除的结直肠癌肝转移转化治疗的研究进展
刘玉星, 刘晨鸣, 杜金林()   
  1. 310030 杭州,浙江大学医学院;321000 浙江大学医学院附属金华医院结直肠肛门外科
    310030 杭州,浙江大学医学院;312000 浙江大学绍兴医院肝胆胰外科
    321000 浙江大学医学院附属金华医院结直肠肛门外科
  • 收稿日期:2023-03-20 出版日期:2023-08-25
  • 通信作者: 杜金林
  • 基金资助:
    金华市科技计划项目(2019-3-004)

Progress in conversion therapy of liver metastasis in initially unresectable colorectal cancer

Yuxing Liu, Chenming Liu, Jinlin Du()   

  1. Medical College of Zhejiang University, Hangzhou 310030, China; Department of Colorectal and Anal Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China
    Medical College of Zhejiang University, Hangzhou 310030, China; Department of Hepatobiliary and Pancreatic Surgery, Shaoxing Hospital of Zhejiang University, Shaoxing 312000, China
    Department of Colorectal and Anal Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China
  • Received:2023-03-20 Published:2023-08-25
  • Corresponding author: Jinlin Du
引用本文:

刘玉星, 刘晨鸣, 杜金林. 初始不可切除的结直肠癌肝转移转化治疗的研究进展[J/OL]. 中华结直肠疾病电子杂志, 2023, 12(04): 337-341.

Yuxing Liu, Chenming Liu, Jinlin Du. Progress in conversion therapy of liver metastasis in initially unresectable colorectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(04): 337-341.

结直肠癌是全球癌症相关死亡的第二大原因,已经成为发病率居全球第三位的恶性肿瘤。大约25%的患者在首次诊断时表现为结直肠癌肝转移(CRLM),手术治疗通常被认为是CRLM患者潜在长期生存的必要条件。CRLM初始可切除患者的中位总生存期(OS)为42个月,5年生存率为35%~40%,而初始可切除率不足20%。因此,通过转化治疗后,对初始不可切除的CRLM进行手术切除,将显著改善CRLM患者的预后。在这篇综述中,我们介绍了关于初始不可切除CRLM转化治疗的最新文献,并讨论了其诊断,治疗方法及疗效等研究进展,以期指导临床实践。

Colorectal cancer is the second largest cause of cancer-related death in the world, and ranks as the third most common malignant tumor in the world. Approximately 25% of patients present with colorectal liver metastases(CRLM) at first diagnosis, and surgical treatment is often considered necessary for the potential long-term survival of patients with CRLM. The median overall survival (OS) of patients who achieved R0 resection in CRLM was 42 months, and the 5-year survival rate was 35%~40%. The initial resectable rate is less than 20%. Therefore, surgical resection of initial unresectable CRLM after conversion therapy will significantly improve the prognosis of patients with CRLM. In this review, we introduce the latest literature on initial unresectable CRLM conversion therapy,and discuss the advances in diagnosis, treatment methods and therapeutic effects, so as to guide clinical practice.

[1]
Global Burden of Disease Cancer C, Fitzmaurice C, Abate D, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: A systematic analysis for the global burden of disease study [J]. JAMA Oncol, 2019, 5(12): 1749-1768.
[2]
Giannis D, Sideris G, Kakos CD, et al. The role of liver transplantation for colorectal liver metastases: A systematic review and pooled analysis [J]. Transplant Rev (Orlando), 2020, 34(4): 100570.
[3]
Adam R, Kitano Y. Multidisciplinary approach of liver metastases from colorectal cancer [J]. Ann Gastroenterol Surg, 2019, 3(1): 50-56.
[4]
Engstrand J, Nilsson H, Strömberg C, et al. Colorectal cancer liver metastases - a population-based study on incidence, management and survival [J]. BMC Cancer, 2018, 18(1): 78.
[5]
Kanas GP, Taylor A, Primrose JN, et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors [J]. Clin Epidemiol, 2012, 4: 283-301.
[6]
Kopetz S, Chang GJ, Overman MJ, et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy [J]. J Clin Oncol, 2009, 27(22): 3677-3683.
[7]
Benson AB, Venook AP, Al-hawary MM, et al. Colon Cancer, Version 2.2021, NCCN clinical practice guidelines in oncology [J]. J Natl Compr Canc Netw, 2021, 19(3): 329-359.
[8]
Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer [J]. Ann Oncol, 2016, 27(8): 1386-1422.
[9]
Bismuth H, Adam R, Lévi F, et al. Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy [J]. Ann Surg, 1996, 224(4): 509-520; discussion 20-22.
[10]
Cai GX, Cai SJ. Multi-modality treatment of colorectal liver metastases [J]. World J Gastroenterol, 2012, 18(1): 16-24.
[11]
Basso M, Dadduzio V, Ardito F, et al. Conversion chemotherapy for technically unresectable colorectal liver metastases: a retrospective, STROBE-compliant, single-center study comparing chemotherapy alone and combination chemotherapy with cetuximab or bevacizumab [J]. Medicine (Baltimore), 2016, 95(20): e3722.
[12]
Leung U, Gönen M, Allen PJ, et al. Colorectal cancer liver metastases and concurrent extrahepatic disease treated with resection [J]. Ann Surg, 2017, 265(1): 158-165.
[13]
Fakih MG. Metastatic colorectal cancer: current state and future directions [J]. J Clin Oncol, 2015, 33(16): 1809-1824.
[14]
Tournigand C, André T, Achille E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study [J]. J Clin Oncol, 2004, 22(2): 229-237.
[15]
Masi G, Vasile E, Loupakis F, et al. Randomized trial of two induction chemotherapy regimens in metastatic colorectal cancer: an updated analysis [J]. J Natl Cancer Inst, 2011, 103(1): 21-30.
[16]
Falcone A, Ricci S, Brunetti I, et al. Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest [J]. J Clin Oncol, 2007, 25(13): 1670-1676.
[17]
Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial [J]. Lancet, 2008, 371(9617): 1007-1016.
[18]
Barone C, Nuzzo G, Cassano A, et al. Final analysis of colorectal cancer patients treated with irinotecan and 5-fluorouracil plus folinic acid neoadjuvant chemotherapy for unresectable liver metastases [J]. Br J Cancer, 2007, 97(8): 1035-1039.
[19]
Adam R, Wicherts DA, De Haas RJ, et al. Patients with initially unresectable colorectal liver metastases: is there a possibility of cure? [J]. J Clin Oncol, 2009, 27(11): 1829-1835.
[20]
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, 2008, 26(12): 2013-2019.
[21]
Giantonio BJ, Levy DE, O'dwyer PJ, et al. A phase II study of high-dose bevacizumab in combination with irinotecan, 5-fluorouracil, leucovorin, as initial therapy for advanced colorectal cancer: results from the Eastern Cooperative Oncology Group study E2200 [J]. Ann Oncol, 2006, 17(9): 1399-1403.
[22]
Okines A, Puerto OD, Cunningham D, et al. Surgery with curative-intent in patients treated with first-line chemotherapy plus bevacizumab for metastatic colorectal cancer First BEAT and the randomised phase-III NO16966 trial [J]. Br J Cancer, 2009, 101(7): 1033-1038.
[23]
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, 2011, 22(9): 2042-2048.
[24]
Cremolini C, Loupakis F, Antoniotti C, et al. Early tumor shrinkage and depth of response predict long-term outcome in metastatic colorectal cancer patients treated with first-line chemotherapy plus bevacizumab: results from phase III TRIBE trial by the Gruppo Oncologico del Nord Ovest [J]. Ann Oncol, 2015, 26(6): 1188-1194.
[25]
Martin RC2nd, Scoggins CR, Schreeder M, et al. Randomized controlled trial of irinotecan drug-eluting beads with simultaneous FOLFOX and bevacizumab for patients with unresectable colorectal liver-limited metastasis [J]. Cancer, 2015, 121(20): 3649-3658.
[26]
Ye LC, Liu TS, Ren L, et al. Randomized controlled trial of cetuximab plus chemotherapy for patients with KRAS wild-type unresectable colorectal liver-limited metastases [J]. J Clin Oncol, 2013, 31(16): 1931-1938.
[27]
Cheng AL, Cornelio G, Shen L, et al. Efficacy, tolerability, and biomarker analyses of once-every-2-weeks cetuximab plus first-line FOLFOX or FOLFIRI in patients with KRAS or all RAS wild-type metastatic colorectal cancer: the phase 2 APEC study [J]. Clin Colorectal Cancer, 2017, 16(2): e73-e88.
[28]
Bokemeyer C, Van Cutsem E, Rougier P, et al. Addition of cetuximab to chemotherapy as first-line treatment for KRAS wild-type metastatic colorectal cancer: pooled analysis of the CRYSTAL and OPUS randomised clinical trials [J]. Eur J Cancer, 2012, 48(10): 1466-1475.
[29]
Folprecht G, Gruenberger T, Bechstein WO, et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial [J]. Lancet Oncol, 2010, 11(1): 38-47.
[30]
Carrato A, Abad A, Massuti B, et al. First-line panitumumab plus FOLFOX4 or FOLFIRI in colorectal cancer with multiple or unresectable liver metastases: A randomised, phase II trial (PLANET-TTD) [J]. Eur J Cancer, 2017, 81: 191-202.
[31]
Diaz L AJr, Shiu KK, Kim TW, et al. Pembrolizumab versus chemotherapy for microsatellite instability-high or mismatch repair-deficient metastatic colorectal cancer (KEYNOTE-177): final analysis of a randomised, open-label, phase 3 study [J]. Lancet Oncol, 2022, 23(5): 659-670.
[32]
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.
[33]
Demisse R, Damle N, Kim E, et al. Neoadjuvant immunotherapy-based systemic treatment in MMR-deficient or MSI-High rectal cancer: case series [J]. J Natl Compr Canc Netw, 2020, 18(7): 798-804.
[34]
Ganesh K, Stadler ZK, Cercek A, et al. Immunotherapy in colorectal cancer: rationale, challenges and potential [J]. Nat Rev Gastroenterol Hepatol, 2019, 16(6): 361-375.
[35]
Fiorentini G, Aliberti C, Tilli M, et al. Intra-arterial infusion of irinotecan-loaded drug-eluting beads (DEBIRI) versus intravenous therapy (FOLFIRI) for hepatic metastases from colorectal cancer: final results of a phase III study [J]. Anticancer Res, 2012, 32(4): 1387-1395.
[36]
Kemeny MM, Adak S, Gray B, et al. Combined-modality treatment for resectable metastatic colorectal carcinoma to the liver: surgical resection of hepatic metastases in combination with continuous infusion of chemotherapy--an intergroup study [J]. J Clin Oncol, 2002, 20(6): 1499-1505.
[37]
Lévi FA, Boige V, Hebbar M, et al. Conversion to resection of liver metastases from colorectal cancer with hepatic artery infusion of combined chemotherapy and systemic cetuximab in multicenter trial OPTILIV [J]. Ann Oncol, 2016, 27(2): 267-274.
[38]
Garlipp B, Gibbs P, Van Hazel GA, et al. Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial [J]. Br J Surg, 2019, 106(13): 1837-1846.
[39]
Cosimelli M, Golfieri R, Cagol PP, et al. Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases [J]. Br J Cancer, 2010, 103(3): 324-331.
[40]
Van Lienden KP, Van Den Esschert JW, De Graaf W, et al. Portal vein embolization before liver resection: a systematic review [J]. Cardiovasc Intervent Radiol, 2013, 36(1): 25-34.
[41]
Adam R, Laurent A, Azoulay D, et al. Two-stage hepatectomy: A planned strategy to treat irresectable liver tumors [J]. Ann Surg, 2000, 232(6): 777-785.
[1] 高俊颖, 张海洲, 区泓乐, 孙强. FOLFOX-HAIC 为基础的肝细胞癌辅助转化治疗的应用进展[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 457-463.
[2] 罗青杉, 梅海涛, 郝家领, 蔡锦锋, 周润楷, 温玉刚. 连接蛋白43通过调控细胞周期抑制结直肠癌的增殖机制研究[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 344-349.
[3] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[4] 谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[5] 施烨鑫, 马翔, 鲁明, 夏青城, 王鹏超, 宋青雨, 赵庆洪. 腹腔镜下结直肠肿瘤定位研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 463-466.
[6] 陈伟杰, 何小东. 胆囊癌免疫靶向治疗进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 763-768.
[7] 严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[8] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[9] 黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[10] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[11] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[12] 任佳琪, 刁德昌, 何自衍, 张雪阳, 唐新, 李文娟, 李洪明, 卢新泉, 易小江. 网膜融合线导向的脾曲游离技术在左半结肠癌根治术中的应用[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 362-367.
[13] 张迪, 王春霞, 张学东, 李发馨, 庞淅文, 陈一锋, 张维胜, 王涛. 梗阻性左半结直肠癌自膨式金属支架置入后行腹腔镜手术与开腹手术的短期临床疗效比较[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 375-380.
[14] 张蔚林, 王哲学, 白峻阁, 黄忠诚, 肖志刚. 利用TCGA数据库构建基于miRNA的结直肠癌列线图预后模型[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 381-388.
[15] 张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
阅读次数
全文


摘要