结直肠癌术前治疗进展

Advances in preoperative treatment of colorectal cancer

结直肠癌术前治疗分为初始可切除的新辅助治疗和初始不可切除的转化治疗。在局部进展期直肠癌中,新辅助放化疗或放疗基础上,增加同步化疗强度,或将术后辅助化疗提至术前,或联合免疫治疗,可增加病理学降期,有助于器官保留,改善患者生存。在局部进展期结肠癌中,新辅助化疗可提高手术效果。在可切除结直肠癌肝转移患者中,推荐合并不良预后因素的患者采用新辅助化疗,是否联合靶向治疗仍存在争议。而在初始不可切除结直肠癌肝转移患者中,分子分型指导下,选择化疗,尤其是三药化疗,联合靶向治疗,有望获得更高的客观反应率和转化切除率,从而接受转化手术切除,改善长期生存。此外,针对错配修复缺陷和微卫星高度不稳定转移性结直肠癌患者,程序性死亡[蛋白]-1单克隆抗体治疗和(或)细胞毒性T淋巴细胞相关抗原-4单克隆抗体已成为标准一线治疗方案。

Preoperative treatment of colorectal cancer includes neoadjuvant therapy for initial resectable patients and conversion therapy for initial unresectable patients.In locally advanced rectal cancer,on the basis of neoadjuvant chemoradiotherapy or radiotherapy,increasing the intensity of concurrent chemotherapy,or raising postoperative adjuvant chemotherapy before surgery,or combining with immunotherapy can increase pathological downstaging,contribute to organ preservation,and improve survival of patients.In locally advanced colon cancer,neoadjuvant chemotherapy can improve surgical outcomes.In patients with resectable colorectal liver metastases,neoadjuvant chemotherapy is recommended in patients with unfavorable prognostic factors,but it remains controversial whether it should be combined with targeted therapy.However,in patients with initially unresectable colorectal liver metastases,under the guidance of molecular typing,chemotherapy,especially triple-drug chemotherapy,combined with targeted therapy,is expected to achieve higher objective response rate and convertible rate,thus accepting surgical resection,which improves long-term survival.In addition,for the patients with mismatch repair deficient/micro-satellite instability-high metastatic colorectal cancer,programmed death-1 monoclonal antibody(mAb)and/or cytotoxic T lymphocyte-associated antigen-4 mAb have become the standard first-line treatment option.