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中华结直肠疾病电子杂志 ›› 2025, Vol. 14 ›› Issue (04) : 307 -318. doi: 10.3877/cma.j.issn.2095-3224.2025.04.003

指南与共识

结直肠癌卵巢转移诊疗专家共识(2025版)
中国医师协会结直肠肿瘤专业委员会   
  • 收稿日期:2025-06-10 出版日期:2025-08-25
  • 基金资助:
    胃肠外科国家临床重点专科基金(No.CZ0185)

Expert consensus on diagnosis and treatment of colorectal cancer with ovarian metastasis (2025 Edition)

Colorectal Cancer Professional Committee of the Chinese Medical Doctor Association   

  • Received:2025-06-10 Published:2025-08-25
引用本文:

中国医师协会结直肠肿瘤专业委员会. 结直肠癌卵巢转移诊疗专家共识(2025版)[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(04): 307-318.

Colorectal Cancer Professional Committee of the Chinese Medical Doctor Association. Expert consensus on diagnosis and treatment of colorectal cancer with ovarian metastasis (2025 Edition)[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2025, 14(04): 307-318.

我国结直肠癌的发病率和死亡率分别位于恶性肿瘤的第二位和第四位。在女性结直肠癌患者中,卵巢转移发生率日益增加,其症状隐匿、进展迅速,对于常规全身治疗敏感性欠佳,临床治疗选择存在一定争议。因此,在中国医师协会结直肠肿瘤专业委员会的组织下,国内相关领域权威专家通过多学科团队讨论对《中国结直肠癌卵巢转移诊疗专家共识(2020版)》进行修订更新,以期指导和规范结直肠癌卵巢转移患者的诊疗流程,制定精准的个体化综合诊疗目标和策略,从而提高我国结直肠肿瘤的整体诊治水平,延长结直肠癌患者生存时间,改善生活质量。

In China, colorectal cancer ranks second in incidence and fourth in mortality among all malignant tumors. The incidence of ovarian metastasis in female colorectal cancer patients is increasing. Characterized by insidious symptoms, rapid progression, and suboptimal sensitivity to conventional systemic therapies, its clinical management remains controversial. To address these challenges, under the guidance of the Colorectal Cancer Professional Committee of the Chinese Medical Doctor Association, authoritative experts in related fields conducted multidisciplinary discussions to revise and update the "Chinese expert consensus on diagnosis and treatment of colorectal cancer with ovarian metastasis (2020 Edition)". This consensus aims to guide and standardize the diagnostic and therapeutic protocols for such patients, establish precise, personalized, and comprehensive treatment goals and strategies, and ultimately enhance the overall diagnosis and treatment standards for colorectal cancer, and prolong survival and improve quality of life for colorectal cancer patients in China.

表1 推荐分级的评估、制定与评价证据质量描述
图1 同时性卵巢转移的诊疗流程注:MDT:多学科团队;NED:无疾病状态;CRS:肿瘤细胞减灭术;HIPEC:腹腔热灌注化疗
图2 异时性卵巢转移的诊疗流程注:MDT:多学科团队;NED:无疾病状态;CRS:肿瘤细胞减灭术;HIPEC:腹腔热灌注化疗
[1]
Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022[J]. J Natl Cancer Cent, 2024, 4(1): 47-53.
[2]
van der Meer R, Bakkers C, Rostamkhan E, et al. Ovarian metastases from colorectal cancer in young women: a systematic review of the literature[J]. Int J Colorectal Dis, 2021, 36(12): 2567-2575.
[3]
Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence[J]. J Clin Epidemiol, 2011, 64(4): 401-406.
[4]
陈怡,张颖,王颖. 结直肠癌卵巢转移的研究现状及进展[J/CD]. 中华结直肠疾病电子杂志, 2020, 9(5): 498-501.
[5]
Kagawa H, Kinugasa Y, Yamaguchi T, et al. Impact of resection for ovarian metastases from colorectal cancer and clinicopathologic analysis: a multicenter retrospective study in Japan[J]. Ann Gastroenterol Surg, 2024, 8(2): 273-283.
[6]
Bakkers C, van der Meer R, Roumen RM, et al. Incidence, risk factors, treatment, and survival of ovarian metastases of colorectal origin: a Dutch population-based study[J]. Int J Colorectal Dis, 2020, 35(6): 1035-1044.
[7]
Yamanishi Y, Koshiyama M, Ohnaka M, et al. Pathways of metastases from primary organs to the ovaries[J]. Obstet Gynecol Int, 2011, 2011: 612817.
[8]
Riihimäki M, Hemminki A, Sundquist J, et al. Patterns of metastasis in colon and rectal cancer[J]. Sci Rep, 2016, 6: 29765.
[9]
van der Meer R, Bakkers C, Wegdam JA, et al. Ovarian metastases in young women with colorectal cancer: a retrospective multicenter cohort study[J]. Int J Colorectal Dis, 2022, 37(8): 1865-1873.
[10]
Ursem C, Zhou M, Paciorek A, et al. Clinicopathologic characteristics and impact of oophorectomy for ovarian metastases from colorectal cancer[J]. Oncologist, 2020, 25(7): 564-571.
[11]
Thornblade LW, Han E, Fong Y. Colorectal cancer ovarian metastases[J]. Int J Gynecol Cancer, 2021, 31(8): 1137-1144.
[12]
Byun JH, Ahn JB, Kim SY, et al. The impact of primary tumor location in patients with metastatic colorectal cancer: a Korean Cancer Study Group CO12-04 study[J]. Korean J Intern Med, 2019, 34(1): 165-177.
[13]
Ojo J, De Silva S, Han E, et al. Krukenberg tumors from colorectal cancer: presentation, treatment and outcomes[J]. Am Surg, 2011,77(10): 1381-1385.
[14]
van der Meer R, Bakkers C, van Erning FN, et al. A propensity score-matched analysis of oncological outcome after systemic therapy for stage IV colorectal cancer: impact of synchronous ovarian metastases[J]. Int J Cancer, 2023,152(6): 1174-1182.
[15]
Xu KY, Gao H, Lian ZJ, et al. Clinical analysis of Krukenberg tumours in patients with colorectal cancer-a review of 57 cases[J]. World J Surg Oncol, 2017, 15(1): 25.
[16]
Van der Meer R, de Hingh IHJT, Bloemen JG, et al. Role of ovarian metastases in colorectal cancer (ROMIC): a Dutch study protocol to evaluate the effect of prophylactic salpingo-oophorectomy in postmenopausal women[J]. BMC Womens Health, 2022, 22(1): 441.
[17]
Ganesh K, Shah RH, Vakiani E, et al. Clinical and genetic determinants of ovarian metastases from colorectal cancer[J]. Cancer, 2017, 123(7): 1134-1143.
[18]
Jiang R, Tang J, Cheng X, et al. Surgical treatment for patients with different origins of Krukenberg tumors: outcomes and prognostic factors[J]. Eur J Surg Oncol, 2009, 35(1): 92-97.
[19]
Sekine K, Hamaguchi T, Shoji H, et al. Retrospective analyses of systemic chemotherapy and cytoreductive surgery for patients with ovarian metastases from colorectal cancer: a single-center experience[J]. Oncology, 2018, 95(4): 220-228.
[20]
Tan KL, Tan WS, Lim JF, et al. Krukenberg tumors of colorectal origin: a dismal outcome--experience of a tertiary center[J]. Int J Colorectal Dis, 2010, 25(2): 233-238.
[21]
Li X, Zhang W, Ding P, et al. Clinical characteristics and prognostic factors of colorectal cancer patients with ovarian metastasis: a multicenter retrospective study[J]. Int J Colorectal Dis, 2021, 36(6): 1201-1208.
[22]
Chen C, Wang D, Ge X, et al. Prognostic factors for ovarian metastases in colorectal cancer patients[J]. World J Surg Oncol, 2021, 19(1): 220.
[23]
Willmott F, Allouni KA, Rockall A. Radiological manifestations of metastasis to the ovary[J]. J Clin Pathol, 2012, 65(7): 585-590.
[24]
Kir G, Gurbuz A, Karateke A, et al. Clinicopathologic and immunohistochemical profile of ovarian metastases from colorectal carcinoma[J]. World J Gastrointest Surg, 2010, 2(4): 109-116.
[25]
Choi HJ, Lee JH, Kang S, et al. Contrast-enhanced CT for differentiation of ovarian metastasis from gastrointestinal tract cancer: stomach cancer versus colon cancer[J]. AJR Am J Roentgenol, 2006, 187(3): 741-745.
[26]
Tanaka YO, Okada S, Satoh T, et al. Diversity in size and signal intensity in multilocular cystic ovarian masses: new parameters for distinguishing metastatic from primary mucinous ovarian neoplasms[J]. J Magn Reson Imaging, 2013, 38(4): 794-801.
[27]
Xu Y, Yang J, Zhang Z, et al. MRI for discriminating metastatic ovarian tumors from primary epithelial ovarian cancers[J]. J Ovarian Res, 2015, 8: 61.
[28]
Cai SQ, Wu MR, Ma XL, et al. Mucin-producing tumors of the ovary--preoperative differentiation between metastatic ovarian mucinous carcinoma and primary mucinous malignant tumors[J]. J Ovarian Res, 2024, 17(1): 59.
[29]
Laurent PE, Thomassin-Piana J, Jalaguier-Coudray A. Mucin-producing tumors of the ovary: MR imaging appearance[J]. Diagn Interv Imaging, 2015, 96(11): 1125-1132.
[30]
Lewis MR, Deavers MT, Silva EG, et al. Ovarian involvement by metastatic colorectal adenocarcinoma: still a diagnostic challenge[J]. Am J Surg Pathol, 2006, 30(2): 177-184.
[31]
Low RN, Sebrechts CP, Barone RM, et al. Diffusion-weighted MRI of peritoneal tumors: comparison with conventional MRI and surgical and histopathologic findings--a feasibility study[J]. AJR Am J Roentgenol, 2009, 193(2): 461-470.
[32]
Namimoto T, Awai K, Nakaura T, et al. Role of diffusion-weighted imaging in the diagnosis of gynecological diseases[J]. Eur Radiol, 2009, 19(3): 745-760.
[33]
Sala E, Rockall A, Rangarajan D, et al. The role of dynamic contrast-enhanced and diffusion weighted magnetic resonance imaging in the female pelvis[J]. Eur J Radiol, 2010, 76(3): 367-385.
[34]
Kyriazi S, Collins DJ, Messiou C, et al. Metastatic ovarian and primary peritoneal cancer: assessing chemotherapy response with diffusion-weighted MR imaging--value of histogram analysis of apparent diffusion coefficients[J]. Radiology, 2011, 261(1): 182-192.
[35]
Sala E, Kataoka MY, Priest AN, et al. Advanced ovarian cancer: multiparametric MR imaging demonstrates response- and metastasis-specific effects[J]. Radiology, 2012, 263(1): 149-159.
[36]
Stukan M, Alcazar JL, Gębicki J, et al. Ultrasound and clinical preoperative characteristics for discrimination between ovarian metastatic colorectal cancer and primary ovarian cancer: a case-control study[J]. Diagnostics (Basel), 2019, 9(4): 210.
[37]
Khiewvan B, Torigian DA, Emamzadehfard S, et al. An update on the role of PET/CT and PET/MRI in ovarian cancer[J]. Eur J Nucl Med Mol Imaging, 2017, 44(6): 1079-1091.
[38]
宋望,郑洪涂,徐烨. 结肠直肠癌卵巢转移的研究进展 [J]. 外科理论与实践, 2017, 22 (3): 261-264.
[39]
Yan D, Du Y, Dai G, et al. Management of synchronous Krukenberg tumors from gastric cancer: a single-center experience[J]. J Cancer, 2018, 9(22): 4197-4203.
[40]
Kim DD, Park IJ, Kim HC, et al. Ovarian metastases from colorectal cancer: a clinicopathological analysis of 103 patients[J]. Colorectal Dis, 2009, 11(1): 32-38.
[41]
Fujiwara A, Noura S, Ohue M, et al. Significance of the resection of ovarian metastasis from colorectal cancers[J]. J Surg Oncol, 2010, 102(6): 582-587.
[42]
Mori Y, Nyuya A, Yasui K, et al. Clinical outcomes of women with ovarian metastases of colorectal cancer treated with oophorectomy with respect to their somatic mutation profiles[J]. Oncotarget, 2018, 9(23): 16477-16488.
[43]
Chung TS, Chang HJ, Jung KH, et al. Role of surgery in the treatment of ovarian metastases from colorectal cancer[J]. J Surg Oncol, 2009, 100(7): 570-574.
[44]
Liu F, Gao Z, Shen D, et al. Significance of SATB2 expression in colon cancer and its differential diagnosis in digestive tract adenocarcinoma and ovarian primary and metastatic carcinoma[J]. Pathol Res Pract, 2019, 215(7): 152430.
[45]
Moh M, Krings G, Ates D, et al. SATB2 expression distinguishes ovarian metastases of colorectal and appendiceal origin from primary ovarian tumors of mucinous or endometrioid type[J]. Am J Surg Pathol, 2016, 40(3): 419-432.
[46]
Aldaoud N, Erashdi M, AlKhatib S, et al. The utility of PAX8 and SATB2 immunohistochemical stains in distinguishing ovarian mucinous neoplasms from colonic and appendiceal mucinous neoplasm[J]. BMC Res Notes, 2019, 12(1): 770.
[47]
Dundr P, Singh N, Nožičková B, et al. Primary mucinous ovarian tumors vs. ovarian metastases from gastrointestinal tract, pancreas and biliary tree: a review of current problematics[J]. Diagn Pathol, 2021, 16(1): 20.
[48]
Rius M, Fusté P, Ros C, et al. HE4 might be a more useful tumor biomarker to detect malignancy in patients with ovarian endometrioma when malignancy is suspected[J]. J Int Med Res, 2021, 49(9): 3000605211047701.
[49]
Shi J, Huang A, Song C, et al. Effect of metastasectomy on the outcome of patients with ovarian metastasis of colorectal cancer: a systematic review and meta-analysis[J]. Eur J Surg Oncol, 2023, 49(9): 106961.
[50]
Mehta AM, Bignell MB, Alves S, et al. Risk of ovarian involvement in advanced colorectal or appendiceal tumors involving the peritoneum[J]. Dis Colon Rectum, 2017, 60(7): 691-696.
[51]
Eveno C, Goéré D, Dartigues P, et al. Ovarian metastasis is associated with retroperitoneal lymph node relapses in women treated for colorectal peritoneal carcinomatosis[J]. Ann Surg Oncol, 2013, 20(2): 491-496.
[52]
何雪铼,曹钦兴,庞明辉. 直肠癌卵巢转移诊治进展[J]. 中华胃肠外科杂志, 2023, 26(3): 295-301.
[53]
Omranipour R, Abasahl A. Ovarian metastases in colorectal cancer[J]. Int J Gynecol Cancer, 2009, 19(9): 1524-1528.
[54]
李晓芬,邱萌. 结直肠癌卵巢转移的临床特征及诊治策略[J]. 肿瘤预防与治疗, 2021, 34: 166-172.
[55]
Liang JT, Lai HS, Wu CT, et al. Laparoscopic prophylactic oophorectomy plus N3 lymphadenectomy for advanced rectosigmoid cancer[J]. Ann Surg Oncol, 2007, 14(7): 1991-1999.
[56]
Nomura M, Tei M, Nishida K, et al. Aggressive surgical intervention may improve prognosis in patients with ovarian metastasis from colorectal cancer[J]. Langenbecks Arch Surg, 2023, 408(1): 313.
[57]
中国医师协会结直肠肿瘤专业委员会腹膜肿瘤专业委员会. 结直肠癌腹膜转移预防和治疗腹腔用药中国专家共识(Ⅴ2019)[J/CD]. 中华结直肠疾病电子杂志, 2019, 8(4): 329-335.
[58]
Garrett CR, George B, Viswanathan C, et al. Survival benefit associated with surgical oophorectomy in patients with colorectal cancer metastatic to the ovary[J]. Clin Colorectal Cancer, 2012, 11(3): 191-194.
[59]
Shariff U, Seretis C, Youssef H. Management of colorectal cancer patients at high risk of peritoneal metastases[J]. J BUON, 2015, 20 (Suppl 1): S71-S79.
[60]
Leung V, Huang N, Liauw W, et al. High risk features of primary colorectal carcinomas which subsequently undergo peritonectomy[J]. Eur J Surg Oncol, 2016, 42(6): 836-840.
[61]
Kyang LS, Valle SJ, Alzahrani NA, et al. Prevention of peritoneal recurrence in high-risk colorectal cancer and evidence of T4 status as a potential risk factor[J]. ANZ J Surg, 2018, 88(10): 975-981.
[62]
中国医师协会结直肠肿瘤专业委员会. 结直肠癌腹膜转移诊治专家共识(2025版)[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(3): 193-201.
[63]
Goéré D, Daveau C, Elias D, et al. The differential response to chemotherapy of ovarian metastases from colorectal carcinoma[J]. Eur J Surg Oncol, 2008, 34(12): 1335-1339.
[64]
Kammar PS, Engineer R, Patil PS, et al. Ovarian metastases of colorectal origin: treatment patterns and factors affecting outcomes[J]. Indian J Surg Oncol, 2017, 8(4): 519-526.
[65]
Al-Busaidi IS, Bailey T, Dobbs B, et al. Complete resection of colorectal cancer with ovarian metastases combined with chemotherapy is associated with improved survival[J]. ANZ J Surg, 2019, 89(9): 1091-1096.
[66]
Kopetz S, Yoshino T, Van Cutsem E, et al. Encorafenib, Cetuximab and chemotherapy in BRAF-mutant colorectal cancer: a randomized phase 3 trial[J]. Nat Med, 2025, 31(3): 901-908.
[67]
Benson AB, Venook AP, Adam M, et al. Colon Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw, 2024, 22(2 D): e240029.
[68]
André 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.
[69]
André T, Lonardi S, Wong KYM, et al. Nivolumab plus low-dose ipilimumab in previously treated patients with microsatellite instability-high/mismatch repair-deficient metastatic colorectal cancer: 4-year follow-up from CheckMate 142[J]. Ann Oncol, 2022, 33(10): 1052-1060.
[70]
Prager GW, Taieb J, Fakih M, et al. Trifluridine-Tipiracil and Bevacizumab in refractory metastatic colorectal cancer[J]. N Engl J Med, 2023, 388(18): 1657-1667.
[71]
Yoshino T, Di Bartolomeo M, Raghav K, et al. Final results of DESTINY-CRC01 investigating trastuzumab deruxtecan in patients with HER2-expressing metastatic colorectal cancer[J]. Nat Commun, 2023, 14(1): 3332.
[72]
Tong G, Luo Q, Pang X, et al. Retrospective analyses of complete resection combined with systemic chemotherapy and targeted therapy for patients with ovarian metastases from colorectal cancer[J]. Cancer Biother Radiopharm, 2022, 37(7): 553-559.
[73]
Xu Y, Feng Q, Chen Y, et al. Significance of surgery in the treatment of colorectal cancer ovarian metastases: a retrospective case matching study[J]. Cancer Manag Res, 2021, 13: 1087-1097.
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