结直肠癌肝转移转化治疗的研究进展

Research progress of conversion therapy in colorectal cancer liver metastases

结直肠癌患者在全病程中发生肝转移的概率达40%~50%,肝转移是影响结直肠癌患者长期预后的重要不利因素。手术切除肝转移灶是唯一可能达到近似根治效果的治疗选择。对于判断为不可切除的肝转移灶,经过综合治疗,使肿瘤缩小,进而将初始不可切除病灶转化为可切除病灶,称为转化治疗。转化治疗可分为以化疗±靶向为主的系统治疗及局部治疗。本文重点综述近年来结直肠癌肝转移转化治疗相关研究成果:(1)梳理肝转移癌手术可切除性评估标准;(2)探讨疗效评估、手术时机及肿瘤侧性对转化治疗方案选择的影响等临床问题;(3)总结转化治疗方案新进展,包括经典双药方案、三药联合的加强方案、分子靶向药物、免疫检查点抑制剂、多种局部疗法以及门静脉栓塞/两步肝切除、联合肝脏分割和门静脉结扎的分步肝切除术在转化治疗中的应用效果。本综述通过分析结直肠癌肝转移转化治疗现有问题,以期为结直肠癌肝转移的临床治疗发展提供参考。

The probability of developing liver metastases in patients with colorectal cancer is 40%-50%.Liver metastases remain an important adverse factor affecting long-term prognosis of colorectal cancer patients.Surgical resection of liver metastases is the only potentially curative treatment option.After comprehensive treatment,initially unresectable liver metastases might be converted to resectable tumors.This concept is known as conversion therapy.In this review,research status of conversion therapy in colorectal cancer liver metastases was summarized,providing updated concept of resectability,discussions on the assessment of tumor response and timing of operation,debates on the influence on tumor sidedness,and latest advancement in the treatment strategy of conversion therapy.Through analyzing existing problems,we hope to offer insights into possible progress in the future and provide references for the development of clinical practice.