Huang Yingying, Jia Wenzhuo, Wang Lijun, Ou Qiuxiang, Wu Xue, Xing Baocai
National Center of Gerontology, Department of Oncology, Beijing Hospital, Beijing 100050, China.
National Center of Gerontology, Department of Oncology, Beijing Hospital, Beijing, China.
Ther Adv Gastrointest Endosc. 2021 Jun 2;14:26317745211020279. doi: 10.1177/26317745211020279. eCollection 2021 Jan-Dec.
Colorectal cancer is the third most common cancer worldwide, and its incidence continues to grow. Approximately one-third of patients with colorectal cancer develop liver metastases during the natural course of disease. Complete surgical resection is associated with very low mortality in colorectal liver metastasis patients, but only a small fraction of colorectal liver metastasis patients fulfill the selection criteria for surgical treatment. We herein describe a high-risk stage-IV rectal carcinoma patient who was initially unresectable according to the National Comprehensive Cancer Network guidelines with a clinical risk score of 4 but received conversion surgery combined with systemic chemotherapy and achieved a favorable long-term clinical outcome (pathologic complete response) of approximately 28 months. Furthermore, serial circulating tumor DNA monitoring using next-generation sequencing provided a comprehensive view of the patient's clinical and pathologic status for better clinical decision support over the course of the disease. The absence of circulating tumor DNA/cells after conversion surgery was correlated with pathologic complete response. This case study not only demonstrated that a curative oncosurgical approach could be considered for high-risk colorectal liver metastasis patients under specific circumstances but also highlighted the role of circulating tumor DNA monitoring to gain further insight into the evolution of a patient's response over time.
结直肠癌是全球第三大常见癌症，其发病率持续上升。在结直肠癌患者的自然病程中，约三分之一会发生肝转移。结直肠癌肝转移患者进行完整手术切除的死亡率非常低，但只有一小部分结直肠癌肝转移患者符合手术治疗的选择标准。我们在此描述了一名高危IV期直肠癌患者，根据美国国立综合癌症网络（National Comprehensive Cancer Network）指南，该患者最初因临床风险评分为4而无法切除，但接受了转化手术联合全身化疗，并获得了约28个月的良好长期临床结局（病理完全缓解）。此外，使用下一代测序进行的连续循环肿瘤DNA监测提供了患者临床和病理状态的全面视图，以便在疾病过程中为临床决策提供更好的支持。转化手术后循环肿瘤DNA/细胞的消失与病理完全缓解相关。本病例研究不仅表明在特定情况下，高危结直肠癌肝转移患者可考虑采用根治性肿瘤外科手术方法，还强调了循环肿瘤DNA监测在深入了解患者随时间变化的反应演变方面的作用。
