局部晚期结肠癌膀胱浸润的研究进展

doi:10.3877/cma.j.issn.2095-3224.2023.06.012

中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (06) : 505 -511. doi: 10.3877/cma.j.issn.2095-3224.2023.06.012

综述

局部晚期结肠癌膀胱浸润的研究进展

蓝冰, 王怀明, 王辉, 马波^†(

)

510655　广州，中山大学附属第六医院普通外科（结直肠外科三区）
510655　广州，中山大学附属第六医院普通外科（结直肠外科三区）；510655　广州市黄埔区中六生物医学创新研究院
510655　广州，中山大学附属第六医院普通外科（结直肠外科三区）；510655　广州，广东省结直肠盆底疾病研究重点实验室
510655　广州，中山大学附属第六医院普通外科（泌尿外科）

收稿日期:2023-03-07 出版日期:2023-12-25
通信作者: 马波
基金资助:
国家自然科学基金项目(No. 82103084); 广东省援疆农村科技（特派员）项目(No. KTPYJ2022030); 中山大学临床研究5010计划(No.2017008，No.2019021)

Research progress on locally advanced colon cancer with bladder invasion

Bing Lan, Huaiming Wang, Hui Wang, Bo Ma^†()

Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
Department of General Surgery (Urology), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China

Received:2023-03-07 Published:2023-12-25
Corresponding author: Bo Ma

全文 ( ) 下载PDF ( ) 导出引用

引用本文：

蓝冰, 王怀明, 王辉, 马波. 局部晚期结肠癌膀胱浸润的研究进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 505-511.

Bing Lan, Huaiming Wang, Hui Wang, Bo Ma. Research progress on locally advanced colon cancer with bladder invasion[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(06): 505-511.

在局部晚期结肠癌患者中，肿瘤浸润膀胱的患者预后较差，随着技术的进步和治疗观念的更新，局部晚期结肠癌的诊断和治疗方法推陈出新。在诊断方面，现已开展的诊断手段有尿红细胞检测、盆腔或腔内B超、膀胱镜、盆腔CT或MRI增强扫描、术中或术后病理诊断等，其中肉眼血尿、膀胱镜检查、CT检查是发现膀胱浸润较为良好的诊断方法。在治疗方面，手术为局部进展期结肠癌的主要治疗方式，术前新辅助治疗是目前的治疗热点。在外科手术中，临床医生综合术前评估等因素，在膀胱部分切除术和全膀胱切除术之间进行选择。目前大多数学者认为，R0切除和预防局部膀胱内复发是结肠癌浸润膀胱患者手术方式选择的关键考虑因素。在围手术期药物治疗方面，新辅助治疗和辅助治疗也有较多研究进展，药物治疗的关键环节在于适宜人群的筛选。本篇综述期望能为临床医生在局部晚期结肠癌患者的诊治环节提供参照依据。

关键词: 结肠肿瘤, 膀胱侵犯, 术前诊断, 围手术期治疗, 研究进展

Among the patients with locally advanced colon cancer, the patients with tumor infiltrating the bladder have a poor prognosis. With the progress of technology and the update of treatment concepts, the diagnosis and treatment methods of locally advanced colon cancer are introduced. In terms of diagnosis, the diagnostic methods currently carried out include urine red blood cell test, pelvic or intracavitary B-ultrasound, cystoscopy, pelvic CT or MRI enhanced scan, intraoperative or postoperative pathological diagnosis, etc. Among them, gross hematuria, cystoscopy, and CT examination are better diagnostic methods for finding bladder infiltration. In terms of treatment, surgery is the main treatment for locally advanced colon cancer, and preoperative neoadjuvant therapy is the current treatment focus. In surgery, clinicians should choose between partial cystectomy and total cystectomy based on preoperative evaluation and other factors. At present, most scholars believe that R0 resection and prevention of local intravesical recurrence are the key factors to consider in the selection of surgical methods for patients with colon cancer infiltrating bladder. In terms of perioperative drug therapy, there are also many research advances in neoadjuvant therapy and adjuvant therapy, and the key link of drug therapy is the screening of suitable population. This review is expected to provide reference for clinicians in the diagnosis and treatment of patients with locally advanced colon cancer.

Key words: Colonic neoplasms, Bladder invasion, Preoperative diagnosis, Perioperative treatment, Research progress

表1 结直肠癌膀胱浸润的相关研究

第一作者	发表国家	发表年份	研究时间	样本量	全切/部分切	总生存率（OS）	局部复发率（LS）	膀胱内复发	病理确诊率
Balbay^[7]	美国	1999	1986~1996	81	9/46	55%	17%	-	60%
Fujisawa^[10]	日本	2002	1970~2001	36	19/17	91%（3yr）	-	-	-
Kobayashi^[3]	日本	2003	1995~2000	17	12/2	-	-	-	46%
Carne^[11]	新西兰	2004	1984~1999	53	45/4	75%	16%	-	39%
Winter^[12]	爱尔兰	2007	1985~2000	63	53/10	57%	14%	-	54%
Gao^[13]	中国	2007	1995~2000	33	28/5	39%	27%	-	29%
Li^[14]	中国	2011	1987~2004	72	58/14	59%	15%	-	47%
Luo^[15]	中国	2013	2000~2011	84	0/84	-	-	8.30%	40%
Hartwig^[16]	丹麦	2016	1997~2012	31	16/15	70%	11%	6.20%	52%
Nerli^[17]	印度	2018	2001~2016	9	8/1	-	-	-	100%
Kondo^[8]	日本	2019	1993~2013	90	18/72	63%	10%	-	37%
Yoshida^[5]	日本	2019	2001~2015	89	40/49	70%/72%	37%/34%	8.20%	42%
Vuillermet^[2]	法国	2020	2010~2017	117	9/108	83%（3yr）	17%	10%	47%
Tsang^[6]	中国	2022	2012~2020	22	5/17	82%（3yr）	9%	-	77%

表1 结直肠癌膀胱浸润的相关研究

第一作者	发表国家	发表年份	研究时间	样本量	全切/部分切	总生存率（OS）	局部复发率（LS）	膀胱内复发	病理确诊率
Balbay^[7]	美国	1999	1986~1996	81	9/46	55%	17%	-	60%
Fujisawa^[10]	日本	2002	1970~2001	36	19/17	91%（3yr）	-	-	-
Kobayashi^[3]	日本	2003	1995~2000	17	12/2	-	-	-	46%
Carne^[11]	新西兰	2004	1984~1999	53	45/4	75%	16%	-	39%
Winter^[12]	爱尔兰	2007	1985~2000	63	53/10	57%	14%	-	54%
Gao^[13]	中国	2007	1995~2000	33	28/5	39%	27%	-	29%
Li^[14]	中国	2011	1987~2004	72	58/14	59%	15%	-	47%
Luo^[15]	中国	2013	2000~2011	84	0/84	-	-	8.30%	40%
Hartwig^[16]	丹麦	2016	1997~2012	31	16/15	70%	11%	6.20%	52%
Nerli^[17]	印度	2018	2001~2016	9	8/1	-	-	-	100%
Kondo^[8]	日本	2019	1993~2013	90	18/72	63%	10%	-	37%
Yoshida^[5]	日本	2019	2001~2015	89	40/49	70%/72%	37%/34%	8.20%	42%
Vuillermet^[2]	法国	2020	2010~2017	117	9/108	83%（3yr）	17%	10%	47%
Tsang^[6]	中国	2022	2012~2020	22	5/17	82%（3yr）	9%	-	77%

[1]	中国抗癌协会, 中国抗癌协会大肠癌专业委员会. 中国恶性肿瘤整合诊治指南-结肠癌部分[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(1): 1-12.
[2]	Vuillermet C, Meillat H, Manceau G, et al. Advanced colonic cancer with clinically suspected bladder invasion: Outcomes and prognosis from a multicentric study of 117 patients from the FRENCH research group[J]. Surgery, 2020, 168(5): 786-792.
[3]	Kobayashi T, Kamoto T, Sugino Y, et al. High incidence of urinary bladder involvement in carcinomas of the sigmoid and rectum: a retrospective review of 580 patients with colorectal carcinoma[J]. J Surg Oncol, 2003, 84(4): 209-214.
[4]	Woranisarakul V, Ramart P, Phinthusophon K, et al. Accuracy of preoperative urinary symptoms, urinalysis, computed tomography and cystoscopic findings for the diagnosis of urinary bladder invasion in patients with colorectal cancer[J]. Asian Pac J Cancer Prev, 2014, 15(17): 7241-7244.
[5]	Yoshida T, Shida D, Taniguchi H, et al. Long-term outcomes following partial versus complete cystectomy in advanced colorectal cancer with regarding to the extent of bladder invasion[J]. Ann Surg Oncol, 2019, 26(5): 1569-1576.
[6]	Tsang YP, Lau CW. Outcomes of partial or total cystectomy in advanced colon cancer with suspected bladder invasion-our 8-year experience and literature review[J]. J Gastrointest Cancer, 2022, 53(2): 394-402.
[7]	Balbay MD, Slaton JW, Trane N, et al. Rationale for bladder-sparing surgery in patients with locally advanced colorectal carcinoma[J]. Cancer, 1999, 86(11): 2212-2216.
[8]	Kondo A, Sasaki T, Kitaguchi D, et al. Resection of the urinary bladder for locally advanced colorectal cancer: a retrospective comparison of partial versus total cystectomy[J]. BMC Surg, 2019, 19(1): 63.
[9]	Yoshida T, Shida D. ASO author reflections: partial versus total cystectomy in bladder-involving colorectal cancer[J]. Ann Surg Oncol, 2019, 26(S3): 686-687.
[10]	Fujisawa M, Nakamura T, Ohno M, et al. Surgical management of the urinary tract in patients with locally advanced colorectal cancer[J]. Urology, 2002, 60(6): 983-987.
[11]	Carne PWG, Frye JNR, Kennedy-Smith A, et al. Local invasion of the bladder with colorectal cancers: surgical management and patterns of local recurrence[J]. Dis Colon Rectum, 2004, 47(1): 44-47.
[12]	Winter DC, Walsh R, Lee G, et al. Local involvement of the urinary bladder in primary colorectal cancer: outcome with en bloc resection[J]. Ann Surg Oncol, 2007, 14(2): 441-446.
[13]	Gao F, Cao YF, Chen LS, et al. Outcome of surgical management of the bladder in advanced colorectal cancer[J]. Int J Colorectal Dis, 2006, 22(1): 21-24.
[14]	Li JC, Chong CC, Ng SS, et al. En bloc urinary bladder resection for locally advanced colorectal cancer: a 17-year experience[J]. Int J Colorectal Dis, 2011, 26(9): 1169-1176.
[15]	Luo HL, Tsai KL, Lin SE, et al. Outcome of urinary bladder recurrence after partial cystectomy for en bloc urinary bladder adherent colorectal cancer resection[J]. Int J Colorectal Dis, 2013, 28(5): 631-635.
[16]	Hartwig MF, Bulut O, Niebuhr M, et al. Local involvement of the lower urinary tract in primary colorectal cancer - outcome after en-bloc resection[J]. Pol Przegl Chir, 2016, 88(2): 99-105.
[17]	Nerli RB, Ghagane SC, Ram P, et al. Bladder invasion in patients with advanced colorectal carcinoma[J]. Indian J Surg Oncol, 2018, 9(4): 547-551.
[18]	丁宇, 李亮, 李柱, 等. 以泌尿系症状首诊的乙状结肠癌临床诊治分析[J]. 海南医学, 2011, 22(13): 76-78.
[19]	Courtney D, McDermott F, Heeney A, et al. Clinical review: surgical management of locally advanced and recurrent colorectal cancer[J]. Langenbecks Arch Surg, 2014, 399(1): 33-40.
[20]	Zafar M, Lee S, Tieger S, et al. Colovesical fistulae: the varying aetiologies[J]. Cureus, 2021, 13(11): e20025.
[21]	Najjar SF, Jamal MK, Savas JF, et al. The spectrum of colovesical fistula and diagnostic paradigm[J]. Am J Surg, 2004, 188(5): 617-621.
[22]	Zizzo M, Tumiati D, Bassi MC, et al. Management of colovesical fistula: a systematic review[J]. Minerva Urol Nephrol, 2022, 74(4): 400-408.
[23]	廖坚松, 陈功, 万德森. 尿红细胞检测在乙状结肠癌侵犯膀胱的术前诊断价值[J]. 广东医学, 2006, 27(7): 1064-1065.
[24]	Skierucha M, Barud W, Baraniak J, et al. Colovesical fistula as the initial manifestation of advanced colon cancer: A case report and review of literature[J]. World J Clin Cases, 2018, 6(12): 538-541.
[25]	Sun Y, Guo Z, Liu X, et al. Noninvasive urinary protein signatures associated with colorectal cancer diagnosis and metastasis[J]. Nat Commun, 2022, 13(1): 2757.
[26]	尹佳园, 李辉. 超声诊断乙状结肠癌侵犯膀胱一例[J/CD]. 中华临床医师杂志:电子版, 2013, 7(1): 432-433.
[27]	卢文献, 张晓辉, 费强. 超声和CT术前诊断结肠癌的价值观察[J]. 中国CT和MRI杂志, 2020, 18(8): 138-140.
[28]	Matulewicz RS, DeLancey JO, Meeks JJ. Cystoscopy[J]. JAMA, 2017, 317(11): 1187.
[29]	Ren J, Huan Y, Li F, et al. Combined T2-weighted and diffusion-weighted MRI for diagnosis of urinary bladder invasion in patients with prostate carcinoma[J]. J Magn Reson Imaging, 2009, 30(2): 351-356.
[30]	Rockall AG, Ghosh S, Alexander-Sefre F, et al. Can MRI rule out bladder and rectal invasion in cervical cancer to help select patients for limited EUA? [J]. Gynecol Oncol, 2006, 101(2): 244-249.
[31]	Lord AC, D’Souza N, Shaw A, et al. MRI-diagnosed tumor deposits and EMVI status have superior prognostic accuracy to current clinical TNM staging in rectal cancer[J]. Ann Surg, 2022, 276(2): 334-344.
[32]	Qiu B, Ding PR, Cai L, et al. Outcomes of preoperative chemoradiotherapy followed by surgery in patients with unresectable locally advanced sigmoid colon cancer[J]. Chin J Cancer, 2016, 35(1): 65.
[33]	Chang H, Yu X, Xiao WW, et al. Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study[J]. Onco Targets Ther, 2018, 11: 409-418.
[34]	Seymour MT, Morton D. FOxTROT: an international randomised controlled trial in 1052 patients (pts) evaluating neoadjuvant chemotherapy (NAC) for colon cancer[J]. JCO, 2019, 37(suppl.15): 3504.
[35]	Jung F, Guidolin K, Lee M, et al. Interventions and outcomes for neoadjuvant treatment of T4 colon cancer: a scoping review[J]. Current Oncology, 2021, 28(3): 2065-2078.
[36]	Gosavi R, Chia C, Michael M, et al. Neoadjuvant chemotherapy in locally advanced colon cancer: a systematic review and meta-analysis[J]. Int J Colorectal Dis, 2021, 36(10): 2063-2070.
[37]	FOxTROT Collaborative Group. Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial[J]. The Lancet Oncology, 2012, 13(11): 1152-1160.
[38]	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, 2016, 34(27): 3300-3307.
[39]	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.
[40]	Benson AB, Venook AP, Cederquist L, et al. Colon cancer, version 1.2017, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2017, 15(3): 370-398.
[41]	Hu H, Kang L, Zhang J, et al. Neoadjuvant PD-1 blockade with toripalimab, with or without celecoxib, in mismatch repair-deficient or microsatellite instability-high, locally advanced, colorectal cancer (PICC): a single-centre, parallel-group, non-comparative, randomised, phase 2 trial[J]. The Lancet Gastroenterology & Hepatology, 2022, 7(1): 38-48.
[42]	Margalit O, Mamtani R, Lawrence YR, et al. Postoperative radiation for pathologic stage T4 colon cancers receiving adjuvant chemotherapy[J]. Clin Colorectal Cancer, 2019, 18(3): 226-230.e2.
[43]	Lin Y, Liu S, Hong L, et al. Postoperative locoregional recurrence pattern and treatment management of stage pT4 sigmoid colon cancer: a retrospective cohort study[J]. Radiat Oncol, 2022, 17(1): 95.
[44]	Lin Y, Wang L, Shao L, et al. Prognostic analysis and beneficiary identification of adjuvant external beam radiotherapy for stage pT4b sigmoid colon cancer[J]. Sci Rep, 2021, 11(1): 11782.
[45]	Weinstein RP, Grob BM, Pachter EM, et al. Partial cystectomy during radical surgery for nonurological malignancy[J]. J Urol, 2001, 66(1): 79-81.
[46]	Diaconescu M, Burada F. T4 colon cancer - current management[J]. Current Health Sciences Journal, 2018, 44(1): 5-13.
[47]	周海涛, 周志祥, 张海增, 等. 结直肠癌侵犯膀胱的治疗[J]. 中国肿瘤临床与康复, 2009, 16(3): 257-260.
[48]	蔡观福, 黄奕华, 汪建平, 等. 局部侵犯期结直肠癌扩大切除术66例的疗效分析[J]. 中华普通外科杂志, 2005, 20(6): 338-340.

[1]	樊逸隽, 杨枫, 王玮, 殷鹤英, 刘俊. 喉前淋巴结转移对甲状腺乳头状癌诊疗价值的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(04): 306-310.
[2]	燕速, 霍博文, 徐惠宁. 4K荧光腹腔镜扩大右半结肠CME+D3根治术及No.206、No.204组淋巴结清扫术[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 14-14.
[3]	姚宏伟, 魏鹏宇, 高加勒, 张忠涛. 不断提高腹腔镜右半结肠癌D3根治术的规范化[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 1-4.
[4]	杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[5]	周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[6]	徐伯麒, 陶亮, 章帆, 毛忠琦. 结肠癌患者淋巴结转移预测模型的建立[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 393-397.
[7]	张林, 刘芳, 赵静, 刘勇, 周青. 远程康复在慢性阻塞性肺疾病患者肺康复中的研究进展[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 601-604.
[8]	李丹阳, 李满祥. 肠道菌群失调在肺动脉高压发病中的研究进展[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 432-434.
[9]	秦富豪, 郑正, 江滨. 间充质干细胞在克罗恩病肛瘘治疗中的研究进展[J]. 中华细胞与干细胞杂志(电子版), 2023, 13(03): 172-177.
[10]	侯文运, 刘恒昌, 窦利州, 陈海鹏, 郑朝旭, 王贵齐, 王锡山. 腹部无辅助切口内镜引导下取标本的腹腔镜辅助右半结肠癌根治术（保留回盲部）（附视频）[J]. 中华结直肠疾病电子杂志, 2023, 12(05): 436-440.
[11]	唐新, 刁德昌, 廖伟林, 林佳鑫, 汪佳豪, 李文娟, 谢嘉欣, 敖琳, 李洪明, 易小江, 卢新泉, 冯晓创. 保留神经的鞘外游离技术在腹腔镜右半结肠癌D3根治术中的近远期疗效分析：基于倾向性评分匹配的回顾性队列研究[J]. 中华结直肠疾病电子杂志, 2023, 12(05): 372-380.
[12]	陈润芝, 杨东梅, 徐慧婷. 信迪利单抗联合索凡替尼后线治疗MSS型BRAF突变的转移性结肠癌：个案报道并文献复习[J]. 中华结直肠疾病电子杂志, 2023, 12(05): 431-435.
[13]	常远, 白杨, 王文秀, 孙振强, 周全博, 崔雯铭, 王玉行, 袁维堂, 胡军红. 电子结肠镜辅助经结肠取标本手术在结肠肿瘤中的临床应用分析[J]. 中华结直肠疾病电子杂志, 2023, 12(03): 196-199.
[14]	邓振汝, 林树文, 吕泽坚, 郑佳彬, 廖乾超, 冯伙伦, 吴德庆, 王俊江, 李勇. 横结肠切除与扩大结肠切除治疗横结肠癌疗效比较[J]. 中华结直肠疾病电子杂志, 2023, 12(03): 214-220.
[15]	吴一菡, 雷章, 卢宏达. MUC16/CA125在良恶性肿瘤诊治中的作用及其研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(05): 591-595.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Research progress on locally advanced colon cancer with bladder invasion

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Research progress on locally advanced colon cancer with bladder invasion