Gül-Klein S, Schmuck R, Modest D P, Pratschke J
Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Charité Mitte | Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
Abteilung für Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Corporate Member der Freien Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Campus Virchow Klinikum, Berlin, Deutschland.
Chirurg. 2020 May;91(5):396-404. doi: 10.1007/s00104-020-01133-7.
Liver metastases represent the most common secondary malignant liver disease. Data regarding the incidence of colorectal and non-colorectal liver metastases are rare due to insufficient documentation in a register. Results regarding neoadjuvant therapy are limited and mostly from retrospective analyses.
A summary and rating of the rationale for neoadjuvant therapeutic concepts for colorectal and non-colorectal liver metastases were performed.
The analysis was based on European and American guidelines and included publications in both German and English languages. The results and recommendations were summarized and a review based on the literature is given.
Neoadjuvant treatment of liver metastases is performed with heterogeneous intentions. The selection of biologically favorable tumors as well as the conversion of primarily non-operable into resectable metastases of the liver are classical reasons for neoadjuvant treatment. The rationale for neoadjuvant treatment of colorectal and especially for non-colorectal liver metastases cannot be answered in a consistently coherent way with respect to the current status quo of the literature and guidelines. The creation of treatment strategies in clinical settings follows criteria, such as patterns of metastases, complexity of the resection and biological factors (metachronous/synchronous metastases, prognostic factors).
Neoadjuvant treatment in the context of conversion therapy is the standard procedure for metastasized colorectal cancer. The biological selection of favorable tumors as the basis for neoadjuvant treatment of resectable lesions is not a consistently used standard for colorectal cancer. Non-colorectal liver metastases are resected only as part of individual concepts.
肝转移是最常见的继发性肝脏恶性疾病。由于登记记录不足，关于结直肠癌和非结直肠癌肝转移发病率的数据很少。新辅助治疗的结果有限，且大多来自回顾性分析。
对结直肠癌和非结直肠癌肝转移新辅助治疗概念的理论依据进行总结和评级。
该分析基于欧美指南，纳入德语和英语语言的出版物。总结了结果和建议，并给出基于文献的综述。
肝转移的新辅助治疗目的各异。选择生物学上有利的肿瘤以及将原本不可切除的肝转移瘤转化为可切除的转移瘤是新辅助治疗的经典原因。就目前的文献和指南现状而言，结直肠癌尤其是非结直肠癌肝转移新辅助治疗的理论依据无法以一致连贯的方式得到解答。临床环境中治疗策略的制定遵循转移模式、切除复杂性和生物学因素（异时性/同时性转移、预后因素）等标准。
转化治疗背景下的新辅助治疗是转移性结直肠癌的标准程序。将生物学上有利的肿瘤作为可切除病变新辅助治疗的基础，并非结直肠癌一直采用的标准。非结直肠癌肝转移仅作为个体化治疗方案的一部分进行切除。
