Xu D, Xing B C
Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2019 Apr 25;22(4):321-328. doi: 10.3760/cma.j.issn.1671-0274.2019.04.003.
The incidence of colorectal cancer liver metastasis (CRLM) increased gradually in recent years. Surgical resection is the most important treatment for CRLM patients to obtain longterm survival, with a 5year survival rate of about 50%. However, only 20% of the CRLM patients are initially resectable. The recurrence rate after surgery is more than 70%. Perioperative chemotherapy has been widely used with the development of effective chemotherapy regimens and targeted therapies. For patients with initially resectable liver metastases, perioperative chemotherapy may help reduce recurrence and prolong survival. For patients with unresectable liver metastases, conversion chemotherapy with high efficiency provides opportunity for radical resection. However, CRLM is a disease with high heterogeneity and with many factors influencing prognosis, and there is a lack of largescale prospective clinical trial evidence in many problems. Hence there are still many controversies in the clinical practice of perioperative chemotherapy, including whether chemotherapy alone is the best preoperative treatment for resectable CRLM, whether preoperative chemotherapy combined with targeted therapy is superior to chemotherapy alone, who can benefit most from preoperative chemotherapy combined with targeted therapy, who are the exact patients suitable for conversion therapy, how to choose the best firstline conversion therapy. Here we discuss the current status of research on perioperative chemotherapy in three aspects: neoadjuvant chemotherapy, conversion therapy and adjuvant chemotherapy. We also emphasized the importance of multidisciplinary team during the treatment process to give patients individualized therapy considering their specific conditions.
近年来，结直肠癌肝转移（CRLM）的发病率逐渐上升。手术切除是CRLM患者获得长期生存的最重要治疗方法，5年生存率约为50%。然而，只有20%的CRLM患者最初可切除。术后复发率超过70%。随着有效化疗方案和靶向治疗的发展，围手术期化疗已被广泛应用。对于最初可切除肝转移的患者，围手术期化疗可能有助于降低复发率并延长生存期。对于不可切除肝转移的患者，高效的转化化疗为根治性切除提供了机会。然而，CRLM是一种高度异质性的疾病，有许多因素影响预后，在许多问题上缺乏大规模前瞻性临床试验证据。因此，围手术期化疗的临床实践仍存在许多争议，包括单纯化疗是否是可切除CRLM的最佳术前治疗方法、术前化疗联合靶向治疗是否优于单纯化疗、谁能从术前化疗联合靶向治疗中获益最大、哪些是适合转化治疗的确切患者、如何选择最佳的一线转化治疗方案。在此，我们从新辅助化疗、转化治疗和辅助化疗三个方面讨论围手术期化疗的研究现状。我们还强调了多学科团队在治疗过程中的重要性，以便根据患者的具体情况给予个体化治疗。
