University of Modena and Reggio Emilia, Department of Oncology and Haematology, via del Pozzo, 71; 41100 Modena, Italy.
J Hematol Oncol. 2009 Aug 6;2:35. doi: 10.1186/1756-8722-2-35.
The complete pathological response after primary chemotherapy could represent an important prognostic factor in patients affected by colorectal liver metastases. In recent studies, increasing complete pathological response seems to be correlated with longer overall survival periods and it is recognized as an important prognostic factor in patients treated with pre-operative chemotherapy. The correlation of radiological information on residual neoplastic disease after neoadjuvant treatment, obtained with CT and PET, has to be evaluated; in fact the complete disappearance of liver metastasis on radiological imaging does not always mean a complete disappearance of tumor tissue on histological examination; when it is documented with surgical procedures and confirmed by pathologist's examination, we can consider the complete pathological response. In recent years the addition of monoclonal antibodies to conventional chemotherapy may further increase the proportion of patients referred for surgery; bevacizumab before surgery has been shown to be feasible and safe, although concerns still exist regarding possible post-surgical and wound healing complications or bleeding. The limitation of the radiologic assessment of response as a surrogate for pathological response is even more relevant when antiangiogenic treatments are used. Excellent responses to bevacizumab-containing regimens do occur and referral to surgical oncology is a crucial step for documentation of complete pathological response.
原发化疗后的完全病理缓解（pathological response）可能是结直肠癌肝转移患者的一个重要预后因素。在最近的研究中，完全病理缓解率的增加似乎与更长的总生存期相关，并且被认为是接受术前化疗的患者的一个重要预后因素。需要评估新辅助治疗后 CT 和 PET 获得的残留肿瘤疾病的影像学信息的相关性；事实上，影像学上肝转移的完全消失并不总是意味着组织学检查中肿瘤组织的完全消失；当通过手术程序记录并由病理学家检查确认时，我们可以认为达到了完全病理缓解。近年来，将单克隆抗体加入常规化疗可能会进一步增加可接受手术的患者比例；在术前使用贝伐珠单抗已被证明是可行且安全的，尽管对术后和伤口愈合并发症或出血的可能性仍存在担忧。当使用抗血管生成治疗时，影像学评估反应作为病理反应替代的局限性更加明显。贝伐珠单抗联合方案的优异反应确实存在，将患者转介至外科肿瘤学是记录完全病理缓解的关键步骤。
