T4期结肠癌的诊断和治疗探讨

Diagnosis and treatment of T4 stage colon cancer

在全球范围内,结直肠癌的发病率和病死率约为10%。T4期结肠癌预后较差,T4b期更甚,5年生存率仅为15.8%~27.9%。目前T4期结肠癌外科诊疗缺乏准确的临床分期评估手段以及系统的围手术期诊疗体系。笔者认为,分期评估仍应以传统CT为主,CT结肠成像可以应用于因肿瘤梗阻结肠镜无法探及全程的患者以及传统CT不易判断的患者。围手术期诊疗方面,T4a期结肠癌患者可采用根治性手术+术后化疗的治疗策略,T4b期患者可采用术前新辅助化疗+根治性手术+术后化疗的治疗策略,新辅助放疗可考虑应用于肿瘤较为固定的患者。此外,应成立多学科合作小组针对复杂T4期结肠癌患者进行讨论。

Colorectal cancer accounts for approximately 10%of all annually diagnosed cancers and cancer deaths in the world.The prognosis of T4 stage colon cancer is poor,and of T4b stage is even worse.The 5-year overall survival of T4b is only 15.8%to 27.9%.Currently,the T4 stage colon cancer is lack of accurate T stage imaging evaluation and systemic perioperative diagnosis and treatment system.In the authors′opinion,for imaging evaluation,computed tomography(CT)is the main technique.CT colonoscopy should be applied to the patients who are unable to explore the entire colon due to tumor obstruction in colonoscopy and the patients who are difficult to estimate via traditional CT.For perioperative diagnosis and treatment system,radical surgery and postoperative chemotherapy could be performed in the T4a colon cancer patients;neoadjuvant chemotherapy,radical surgery and postoperative chemotherapy could be performed in the T4b colon cancer patients;neoadjuvant radiotherapy could be performed in the patients whose tumor is fixed.Moreover,multiple disciplinary team(MDT)should be established for the complicated T4 colon cancer patients.