结直肠癌肝转移化疗后消失病灶的进展

TreatmentAdvance for Disappearing Liver Metastases AfterChemotherapy in Colorectal Liver Metastases

超过50%的结直肠癌转移患者会发生肝转移,手术切除是唯一可能治愈的方法。欧洲肿瘤治疗研究协作组(EORTC)40983研究表明可切除的结直肠癌肝转移行术前化疗对比单纯手术可以提高3年无进展生存率(PFS)9.2%;而不可切除的结直肠癌肝转移应首选有效的化疗及靶向治疗,部分患者经转化后可获得手术切除的机会。如出现化疗后肝转移灶影像学上消失(CRR)(4%～38%),应用肝动脉灌注化疗(HAI)、患者小于60岁、低CEA水平的患者容易获得临床完全缓解(CCR),而临床完全缓解(CCR)并非是病理完全缓解(CPR),CCR病灶留在原位未做处理有较高的复发率,但术后的5年生存率可高达40%～80%,因此不应作为手术的禁忌症。为获得R0切除,可以考虑联合应用门静脉栓塞/门静脉结扎(PVE/PVL)、射频消融(RFA)等治疗手段。为降低复发风险,可考虑辅助HAI及全身化疗。

More than 50% colorectal cancer patients will develop liver metastases throughout their whole disease process, and liver resection remains the only hope to cure this malignance. EORTC 40983 trial found that hepatectomy plus chemotherapy improved progress -free survival （PFS） by 9.2% compared to resection only for resectable colorectal liver metastases （CRLM）. The primary treatment is intensive chemotherapy and target therapy if possible for unresectable CRLM, some patients could receive surgery after the downsizing of CRLM. Disappearing liver metastases could happen in 4% -38% patients radiologieally. Hepatic artery infusion （HAI） chemotherapy, age less than 60 years and low CEA level are predictors for complete clinical response （CCR）. CCR is not the same to complete patho- logical response （CPR）. Despite the high recurrence in CRLM patients if their DLM were left untreated in situ, 5 -year survival rate could reach 40% -80%, so DLM left in situ was no longer the surgery contraindication. Liver resection combined with portal vein ligation/portal vein embolization （PVE/PVL） and RFA could be used to acquire R0 resection. Adjuvant HAI and systemic chemotherapy might lower recurrence rate of CRLM.