Sinicrope F A, Sugarman S M
Department of Gastrointestinal Medical Oncology and Digestive Diseases, University of Texas M.D. Anderson Cancer Center, Houston, USA.
Gastroenterology. 1995 Sep;109(3):984-93. doi: 10.1016/0016-5085(95)90410-7.
An important advance in cancer treatment has been made in recent years with the finding that adjuvant therapy can significantly improve the survival of patients with colorectal cancer. In patients with resected lymph node-positive colon carcinomas (TNM stage 3), adjuvant 5-fluorouracil and levamisole produced an unequivocal survival advantage that established this combination as the standard of clinical practice. Given that biochemical modulation of fluorouracil by leucovorin can increase response rates in advanced disease, this combination is undergoing evaluation as an adjuvant treatment. Preliminary results indicate that 5-fluorouracil and leucovorin are effective in reducing disease relapse; however, the effect of this regimen on patient survival rates awaits extended follow-up. In the treatment of stages 2 and 3 rectal cancer, significant reductions in local recurrence and death rates have been achieved with the combination of 5-fluorouracil and radiation therapy. Immunologic approaches and newer chemotherapeutic agents may further improve patient outcome and are under investigation, as are efforts to reduce the toxic effects of cancer chemotherapy. Increased understanding of the biology of these diseases is likely to yield prognostic markers capable of identifying subgroups of earlier stage patients at high risk of disease relapse who may also benefit from adjuvant therapy.
近年来，随着辅助治疗可显著提高结直肠癌患者生存率这一发现，癌症治疗取得了重要进展。在已切除的淋巴结阳性结肠癌患者（TNM 分期 3 期）中，辅助使用 5-氟尿嘧啶和左旋咪唑产生了明确的生存优势，使这种联合治疗成为临床实践的标准。鉴于亚叶酸对氟尿嘧啶的生化调节可提高晚期疾病的缓解率，这种联合治疗正在作为辅助治疗进行评估。初步结果表明，5-氟尿嘧啶和亚叶酸在降低疾病复发方面有效；然而，该方案对患者生存率的影响有待延长随访期来确定。在治疗 2 期和 3 期直肠癌时，5-氟尿嘧啶与放射治疗联合使用已显著降低了局部复发率和死亡率。免疫治疗方法和更新的化疗药物可能会进一步改善患者预后，目前正在进行研究，同时也在努力降低癌症化疗的毒性作用。对这些疾病生物学特性的深入了解可能会产生能够识别早期阶段高疾病复发风险亚组患者的预后标志物，这些患者也可能从辅助治疗中获益。
