基于器官保留的局部进展期结直肠癌新辅助治疗研究进展  

Neoadjuvant strategy for locally advanced colorectal cancer based organ preservation

作　　者：吴泽华 程怡 胡华斌[1] 张剑威 邓艳红[1] Wu Zehua;Cheng Yi;Hu Huabin;Zhang Jianwei;Deng Yanhong(Department of Oncology,the Sixth Affiliated Hospital of Sun Yat-sen University,Biomedical Innovation Center,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院肿瘤内科、广州市黄埔区中六生物医学创新研究院,广州1510655

出　　处：《中华胃肠外科杂志》2024年第4期416-423,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(82272800);广东省消化系统疾病临床医学研究中心项目(2020B1111170004)。

摘　　要：局部进展期结直肠癌新辅助治疗在过去20年已取得较大进步,但仍存在不良反应、器官功能障碍及远期转移控制不理想等局限性。而近年来,随着手术技术的提高和肿瘤分子分型研究的进一步发展,如何进一步提高局部控制率,减少远处转移率,甚至根据临床缓解情况免除手术、保留器官是当前患者的需求所在和研究目标。随着分子分型研究的进展,结直肠癌根据微卫星状态和错配修复基因不同,有不同的治疗策略。对于微卫星不稳定局部进展期结直肠癌而言,与传统放化疗相比,免疫检查点抑制剂治疗在提高临床完全缓解率的同时,还可明显降低不良反应发生率、改善器官功能。对于微卫星稳定型局部进展期结肠癌而言,新辅助治疗目前仍处于探索阶段,标准治疗模式仍是手术结合围手术期化疗。对于微卫星稳定型局部进展期直肠癌,一方面通过加强新辅助治疗提高完全缓解率,提高器官保留率,另一方面通过选择性去放疗,保存器官功能,提高生活质量。本文针对基于器官保留策略的局部进展期结直肠癌新辅助治疗策略进行综述。Neoadjuvant therapy for locally advanced colorectal cancer has made great progress in the past 20 years,but there are still limitations such as side effects,organ dysfunction and unsatisfactory control of metastasis.In recent years,with the improvement of surgical techniques and further development of molecular research,how to further improve local control,reduce distant metastasis,and even avoid surgery according to clinical remission to achieve organ preservation,is the current demand and research goal.With the advancement of molecular research,colorectal cancer has different treatment strategies based on microsatellite status.For patients with microsatellite instability locally advanced colorectal cancer,immune checkpoint inhibitor therapy significantly increased the pathologic complete response rate,reduced the incidence of adverse events and improved organ function compared with conventional chemoradiotherapy.For patients with microsatellite stable locally advanced colon cancer,neoadjuvant therapy is still in the exploratory stage.The standard of care is surgery combined with perioperative chemotherapy.For microsatellite stable locally advanced rectal cancer,the complete response rate is improved by enhancing neoadjuvant therapy,which helps to preserve organs.On the other hand,selective radiotherapy preserves organ function and improves quality of life.This article reviews the neoadjuvant treatment strategies for locally advanced colorectal cancer based on organ-sparing strategies。

关 键 词：结直肠肿瘤 局部进展期 微卫星稳定 新辅助治疗 临床完全缓解 器官保留 

分 类 号：R735.34[医药卫生—肿瘤]