Bottarelli Lorena, De' Angelis Gian Luigi, Azzoni Cinzia, Di Mario Francesco, De' Angelis Nicola, Leandro Gioacchino, Fornaroli Fabiola, Gaiani Federica, Negri Francesca
Department of Medicine and Surgery, Unit of Pathological Anatomy, University Hospital of Parma, Parma, Italy.
Acta Biomed. 2018 Dec 17;89(9-S):102-106. doi: 10.23750/abm.v89i9-S.7881.
Fluorouracil-based preoperative chemoradiotherapy represents a standard option for the treatment of locally advanced rectal cancer. Randomized clinical trials have shown that fluorouracil concomitant to preoperative radiation enhances tumor shrinkage (with 10% to 15% of the patients showing a complete pathological tumor response) compared with preoperative radiation alone. A high response rate is of clinical importance in rectal cancer, since patients who achieve a complete pathological response may experience improved long-term survival. Adding oxaliplatin to fluorouracil-based preoperative chemoradiotherapy has no effect on response of the primary rectal tumor and single-agent fluoropyrimidine remains the standard chemotherapy in this setting. Despite novel biological insights and therapeutic advances, little is known about potential biological markers able to predict pathological tumor response before treatment and to subsequently impact patients' prognosis. This review focuses on the current available data on main molecular markers and molecular subtypes and the possible upcoming introduction of such analyses in the clinical setting.
基于氟尿嘧啶的术前放化疗是局部晚期直肠癌治疗的标准选择。随机临床试验表明，与单纯术前放疗相比，术前放疗同时使用氟尿嘧啶可增强肿瘤缩小（10%至15%的患者显示肿瘤完全病理缓解）。高缓解率在直肠癌中具有临床重要性，因为实现完全病理缓解的患者可能有更好的长期生存率。在基于氟尿嘧啶的术前放化疗中添加奥沙利铂对原发性直肠肿瘤的缓解无影响，单药氟嘧啶仍是这种情况下的标准化疗。尽管有新的生物学见解和治疗进展，但对于能够在治疗前预测肿瘤病理反应并随后影响患者预后的潜在生物标志物知之甚少。本综述重点关注主要分子标志物和分子亚型的现有数据，以及此类分析在临床环境中可能即将引入的情况。
