结肠癌肝转移的治疗进展

Recent advances in the treatment of colorectal cancer liver metastases

近年来，结直肠癌（CRC）发病率呈逐渐增高、年轻化趋势。每年全世界有120万新发病例。即使行根治术治疗，依然有25％～40％的患者出现异时性肝转移。结肠癌肝转移（CRLM）作为治疗难点及主要死亡原因之一，20％的患者在初诊时既发现有同时性肝转移。行原发灶及肝转移灶的切除是目前公认唯一可能治愈CRLM的方式。近年来随着外科技术的发展、围手术期药物使用的规范、多学科综合治疗团队（MDT）模式的开展以及定向治疗技术等的发展，患者生存率虽有显著提高，但是，肝切除术后1年复发率仍接近50％，将近80％的CRLM患者初诊就失去了手术机会。面对庞大的CRLM群体，如何将患者个体情况、肝转移分期、术前预后评估、围手术辅助治疗、定向治疗方法等结合在一起，制定系统有效的治疗方案已成为目前研究关注的重点。本文就相关进展进行综述。

In recent years, the morbidity of colorectal cancer （CRC） has gradually increased, and trends to be younger. There are 1.2 million new patients suffering from CRC in the worldwide each year. Even undergoing radical mastectomy, there are still 25% - 40% of patients complicated with heterochronic liver metastasis simuhaneously. The colorectal cancer liver metastasis （CRLM） has become one of the difficulties and the major cause of death, which is diagnosed in 20% of patients at the same time of initial diagnosis. At present, the primary and metastatic cancer on liver resection is recognized as the only way to cure CRLM. in recent years, with the development of surgical technology, the normative use of peri-operative drugs, the collaboration of the mode of multidisciplinary team （MDT） and the development of the technology of targeted therapy, the survival rate of patients has been improved significantly. But the recurrence rate within 1 year is nearly 50 % after hepatectomy. Nearly 80 % of patients with CRLM missed opportunity for surgery when they were first diagnosed. Facing a huge group of CRLM, how to combine the patients＇ individual characteristics, the periodization of liver metastasis, the preoperative prognosis evaluation, the peri-operative adjuvant therapy and the directional treatment method etc. to form a systematic and effective therapeutic schedule has become the present focus attention, which still contains some outstanding issues. This article reviews the relevant progress.