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中国癌症防治杂志

中国癌症防治杂志 ›› 2015, Vol. 7 ›› Issue (1): 32-36.doi: 10.3969/j.issn.1674-5671.2015.01.07

• 临床研究 • 上一篇    下一篇

新辅助化疗在结直肠癌肝转移治疗中的作用

  

  1. 广西医科大学附属肿瘤医院胃肠外科；广西贵港市人民医院消化内科
  • 出版日期:2015-02-25 发布日期:2015-02-28
  • 通讯作者: 林源。E-mail：doctoryuanlin@sina.cn
  • 基金资助:

    广西科学研究与技术开发计划资助项目（桂科攻1140003A-35）

The significance of neoadjuvant chemotherapy for inhibiting colorectal liver metastasis

  • Online:2015-02-25 Published:2015-02-28

PDF (PC)

374

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被引次数

6

摘要：

目的 探讨新辅助化疗在结直肠癌肝转移治疗中的作用。方法 选取76例接受新辅助化疗的结直肠癌肝转移患者，观察新辅助化疗前后原发灶及肝转移灶大小、血清CEA水平变化情况，分析其根治性手术切除率、化疗不良反应、手术并发症以及根治性手术切除患者及其他治疗方式患者的2年生存情况。结果 新辅助化疗后，大部分患者原发灶、肝转移灶体积明显缩小，血清CEA水平明显下降，与接受新辅助化疗前相比，差异有统计学意义（P＜0.05）。其中肝转移灶获CR 0 例，PR 51 例， SD 24 例， PD 1例， 有效率为66.11%（51/76）；原发灶获CR 0 例，PR 44 例， SD 30例， PD 2例， 有效率为57.89% （44/76）。新辅助化疗不良反应以周围神经炎、消化道反应、骨髓抑制等为主，多为Ⅰ～Ⅱ级，未出现Ⅳ级不良反应。根治性手术切除率为30.26%（23/76），手术并发症发生率为3.95%（3/23）。Kaplan-Meier生存分析显示，行根治性手术切除的结直肠癌肝转移患者2年生存情况显著优于其他治疗方法的患者（P＜0.05）。结论 新辅助化疗应用于肝转移灶潜在可切除的结直肠癌肝转移患者，使部分患者肝转移灶缩小，提高根治性手术切除率，改善预后，不良反应可耐受，是一种安全、有效的治疗方法。

关键词: 结直肠肿瘤, 肝转移, 新辅助化疗, 手术治疗

Abstract:

Objective To investigate the efficacy of neoadjuvant chemotherapy for inhibiting colorectal liver metastasis. Methods Clinical records of 76 patients who were treated for colorectal liver cancer metastasis at the Affiliated Tumor Hospital of Guangxi Medical University were retrospectively analyzed. All patients underwent neoadjuvant chemotherapy before surgery. The following patient data were analyzed： size of the primary colorectal cancer and its liver metastases，serum CEA levels before and after neoadjuvant chemotherapy，radical resection，chemotherapy side effects， surgical complications and 2-year survival. Results The size of the primary tumor and its liver metastases decreased significantly after neoadjuvant chemotherapy in most patients， as did serum CEA levels （P＜0.05）. The objective response rate for liver metastases was 66.11%（51/76），with 0 cases of complete remission （CR），51 partial remission （PR），24 stable disease（SD），and 1 progressive disease （PD）. The objective response rate for primary tumors was 57.89%（44/76），with 0 cases of CR，44 PR，30 SD，and 2 PD. The main side effects of neoadjuvant chemotherapy were peripheral nerve toxicity，myelosup-presion and gastrointestinal reaction. The rate of radical resection was 30.26%（23/76），and the rate of surgical complications was 3.95%. The 2-year survival rate was significantly higher among patients treated by radical resection than among those who did not receive this treatment. Conclusion Neoadjuvant chemotherapy is effective and tolerable for patients with colorectal liver metastases. It may improve not only the radical resection rate but also prognosis.

Key words: Colorectal neoplasm, Liver metastases, Neoadjuvant chemotherapy, Surgery