胃肠道癌腹膜转移的化疗策略  

Strategies of chemotherapy for peritoneal metastasis of gastrointestinal cancer

作　　者：施敏[1] 张俊[1] Shi Min;Zhang Jun(Department of Oncology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,State Key Laboratory of Oncogenes and Related Genes,Shanghai Jiao Tong University,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院肿瘤科,癌基因与相关基因国家重点实验室,200025

出　　处：《中华胃肠外科杂志》2021年第3期214-219,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81972707、81672327);上海市青年科技启明星计划(20QA1406200);上海市卫生和计划生育委员会基金(20184Y0048)。

摘　　要：腹膜转移是严重影响胃肠道癌患者预后的独立不良因素,"种子-土壤"学说被认为是解释腹膜转移的主要理论。由于腹膜转移结节初发时体积小,早期诊断尤为困难,因此,腹膜转移的风险评估就显得尤为重要。目前诊断方法已由临床病理因素逐渐向细胞学、乃至分子层面纵深发展,而包括影像组学在内的多组学整合评估,也进一步丰富了腹膜转移的精准诊断。腹膜转移可导致癌性腹水、肠梗阻及恶液质等相关并发症,是胃肠道癌治疗的难点。以系统化疗为基础、手术和腹腔热灌注化疗(HIPEC)等多种方法相结合,是胃肠道癌腹膜转移的有效治疗手段。如何富集潜在获益的腹膜转移患者,如何判定转化手术的时机,如何进一步优化现有治疗方案,特别是转化手术后的患者如何制定治疗方案等,仍需通过完善研究设计和开展前瞻性随机对照研究来解决。切实延长胃肠道癌腹膜转移患者的生存期,是持续努力的目标。Peritoneal metastasis of gastrointestinal cancer is an independent factor that seriously affects the prognosis of patients.The"seed-soil"theory is considered to be the main theory to explain peritoneal metastasis.Because of the small size of peritoneal metastatic nodules at the initial stage,early diagnosis is particularly difficult,therefore,the risk assessment of peritoneal metastasis is very important.Recently,the diagnosis methods have gradually developed from clinicopathological factors to cytology and molecular level.In addition,the integrated assessment of multiple groups including radiomics further enriches the accurate diagnosis of peritoneal metastasis.Peritoneal metastasis is a big challenge in the treatment of gastrointestinal cancer which may also lead to refractory malignant ascites,intestinal obstruction,cachexia and other related complications.At present,the treatment is based on systemic chemotherapy.The combination of surgery,intraperitoneal chemotherapy and HIPEC is an effective treatment for peritoneal metastasis of gastrointestinal cancer.How to enrich peritoneal metastasis patients with potential benefits,how to determine the timing of conversion surgery,how to further optimize the existing treatment plan,especially how to formulate treatment plan for patients after conversion surgery,call for improved study design and prospective randomized controlled trials.The goal of continuous efforts is to effectively prolong the survival of gastrointestinal cancer trials patients with peritoneal metastasis.

关 键 词：胃肠肿瘤 腹膜转移 化疗 评估 预防 诊断 

分 类 号：R735[医药卫生—肿瘤]