Longley Daniel B, McDermott Ultan, Johnston Patrick G
Department of Oncology, Cancer Research Centre, Queen's University Belfast, Northern Ireland.
Clin Colorectal Cancer. 2003 Feb;2(4):223-30. doi: 10.3816/CCC.2003.n.003.
Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Although there is clear evidence of the benefit of chemotherapy in adjuvant and metastatic settings, its use continues to be suboptimal because of intrinsic or acquired drug resistance. 5-Fluorouracil continues to be the mainstay of CRC therapy, and combinations with newer chemotherapeutic agents such as irinotecan and oxaliplatin have resulted in improved response rates and survival. The role of other agents including cyclooxygenase-2 inhibitors, epidermal growth factor receptor, and farnsyl transferase inhibitors remains to be elucidated. Despite these improvements, many patients undergo chemotherapy without benefit. Increased understanding of the biology of CRC has led to the identification of prognostic markers that may help identify patients who will benefit from chemotherapy. Furthermore, studies have also begun to identify markers that predict whether a tumor will respond to a particular chemotherapy. The ultimate goal of this research is to prospectively identify patients who should receive chemotherapy and, thus, to tailor treatment to the molecular profile of the tumor and patient. Such an approach has the potential to dramatically improve response rates. This review highlights potentially important prognostic and predictive factors in CRC and discusses the potential for their use in the treatment of this disease.
结直肠癌（CRC）是美国癌症死亡的第二大主要原因。尽管有明确证据表明化疗在辅助治疗和转移性疾病治疗中有益，但由于内在或获得性耐药，其使用仍未达到最佳效果。5-氟尿嘧啶仍然是CRC治疗的主要药物，与伊立替康和奥沙利铂等新型化疗药物联合使用已提高了缓解率和生存率。包括环氧合酶-2抑制剂、表皮生长因子受体和法尼基转移酶抑制剂在内的其他药物的作用仍有待阐明。尽管有这些进展，但许多患者接受化疗并无益处。对CRC生物学的深入了解已导致识别出可能有助于确定哪些患者将从化疗中获益的预后标志物。此外，研究也已开始识别预测肿瘤是否会对特定化疗产生反应的标志物。这项研究的最终目标是前瞻性地确定应接受化疗的患者，从而根据肿瘤和患者的分子特征量身定制治疗方案。这种方法有可能显著提高缓解率。本综述重点介绍了CRC中潜在重要的预后和预测因素，并讨论了它们在该疾病治疗中的应用潜力。
