结直肠癌肝转移转化治疗的争议与思考

Rethinking of the conversion therapy in colorectal cancer patients with liver metastasis

结直肠癌肝转移(CRLM)的发病率近年来逐渐升高。手术切除是CRLM患者获得长期生存的主要手段,但是只有20%的患者有手术切除的机会。通过有效的转化治疗使初诊时不可切除的CRLM转化为可切除并进行外科手术,患者的5年生存率可超过30%,显著优于接受单纯的姑息治疗。因此对于初诊时不可切除的患者,合理地制订转化治疗策略使初诊时不可切除的CRLM转化为可切除,是提高CRLM患者长期生存的关键,但在临床实践中还存在不少争议。笔者根据自身的经验并结合既往的相关研究,分别从转化治疗的适用人群、转化治疗方案的选择以及化疗后消失病灶的认识与处理3个方面进行了探讨。

The incidence of colorectal cancer liver metastasis (CRLM) has gradually increased in recent years. Surgical resection is the main method to achieve long-term survival for patients with CRLM. However, only 20% of these patients have the chance to undergo surgical resection. If the unresectable metastases can be converted to resectable ones by effective conversion therapy, the 5-year survival rate of patients received liver resection can exceed to 30%, which is significantly better than palliative treatment. Therefore, for patients who are initially unresectable, rationally developing a conversion therapy strategy to convert the initial unresectable CRLM into resectable ones is the key to improve the long-term survival of CRLM patients. However, there are still many controversies in clinical practice. In this article, we discuss three critical issues related to the conversion therapy for CRLM based on previous related researches and our experience, including the applicable population of conversion therapy, how to choose a conversion regime and the recognition and treatment of disappeared lesions after chemotherapy.