Hospital Sírio Libanês, São Paulo, Brazil.
Clin Colorectal Cancer. 2011 Sep;10(3):178-82. doi: 10.1016/j.clcc.2011.03.023. Epub 2011 Apr 24.
BACKGROUND/PURPOSE: The median survival for patients with metastatic colorectal cancer (mCRC) has progressively increased over the past decades. Since the introduction of 5-fluorouracil (5-FU)-based chemotherapy, followed by hepatic resection of metastases, and more recently the adoption of newer chemotherapeutic regimens associated with targeted therapy, the gains are getting more substantial. Despite the recognition of the potential for long-term survival after surgical resection of metastatic disease, long-term survival data to determine the potential curative role of chemotherapy alone is lacking.
We performed a retrospective review of 2751 patients who presented with mCRC at The MD Anderson Cancer Center from 1990 through 2003. Patients alive at 5 years who achieved complete response with chemotherapy and were not submitted to any surgical or interventional procedures directed to the metastatic sites were included in the analysis.
The 5-year overall survival rate for all patients with mCRC during this period was 10.8%. Among these long-term survivors, 2.2% achieved a sustained complete response after chemotherapy (all 6 with fluoropyrimidines and 2 with irinotecan) as the only treatment modality and were without evidence of disease until the last follow-up visit (median of 10.3 years). This number corresponds to 0.24% (6 of 2541) of all patients with mCRC included in this review.
Cure with chemotherapy alone is possible for a very small number of patients with metastatic colorectal cancer. Improved therapies are increasing complete response rates, but the impact of modern chemotherapy on durable complete responses will require additional follow up.
背景/目的：过去几十年来，转移性结直肠癌（mCRC）患者的中位生存期逐渐延长。自氟尿嘧啶（5-FU）为基础的化疗、肝转移灶切除术，以及最近采用与靶向治疗相关的新型化疗方案以来，这种改善越来越显著。尽管手术切除转移性疾病后有长期生存的潜力，但缺乏单独化疗长期生存数据来确定其潜在的治愈作用。
我们对 1990 年至 2003 年在 MD 安德森癌症中心就诊的 2751 例 mCRC 患者进行了回顾性研究。化疗后完全缓解且未接受任何针对转移灶的手术或介入治疗的存活 5 年的患者纳入分析。
在此期间，所有 mCRC 患者的 5 年总生存率为 10.8%。在这些长期幸存者中，有 2.2%（6 例接受氟嘧啶类药物，2 例接受伊立替康）在化疗后达到持续完全缓解（所有患者均未接受任何其他治疗），且在最后一次随访时未发现疾病（中位数为 10.3 年）。这一数字相当于纳入本研究的 2541 例 mCRC 患者中的 0.24%（6 例）。
对于少数转移性结直肠癌患者，单独化疗即可治愈。改良疗法提高了完全缓解率，但现代化疗对持久完全缓解的影响需要进一步随访。
