结直肠癌肝转移围术期化疗研究进展

Recent advances in perioperative chemotherapy for colorectal liver metastases

结直肠癌患者在治疗后的随访中大约50%~60%会发生转移,肝脏为最常转移的器官。手术切除是结直肠癌肝转移最主要和最有效的治疗手段,但考虑其中仅少数肝转移为可切除以及转移灶切除后的高复发风险。围术期化疗已经在多项研究中进行了探讨,目的以增加手术机会、降低复发风险。但在治疗期间患者化疗相关性肝损伤的发生与发展严重影响手术切除后预后,如何对其进行相关危险因素预测对预后具有重要意义。与此同时,肿瘤相关基因检测的飞速发展,如RAS基因的突变状态不仅对靶向药物治疗具有重要意义,当前对于手术切除预后也具有评估意义。此外,肝动脉灌注化疗(hepatic arterial infusionchemotherapy,HAIC)等局部治疗技术的涌现已纳入多项临床研究,并取得一定成果。本文就以上几方面的相关进展作一综述。

In patients with colorectal cancer,metastasis occurs at about50%~60%after treatment,and the liver is the most frequently metastatic organ.Surgical resection is the most important and effective treatment for liver metastasis of colorectal cancer,but only a few liver metastases are considered resectable and the risk of recurrence is high after resection.Perioperative chemotherapy has been studied in several studies with the aim of increasing surgical opportunities and reducing the risk of recurrence.However,during the treatment period,the occurrence and development of chemotherapy related liver injury seriously affect the prognosis after surgery,and how to predict the related risk factors is of great significance to prognosis.At the same time,the rapid development of tumor associated gene testing,such as mutation status of RAS gene,is not only important for targeted drug therapy,but also has a guiding signifi cance for the prognosis of surgical resection.In addition,the emergence of local treatment techniques such as hepatic arterial infusion chemotherapy has been included in a number of clinical studies and achieved certain results.In this paper,the progress in the above aspects is reviewed.