结肠癌的辅助化疗 - 第三军医大学学报.doc

结肠癌术后辅助化疗的共识与争议 梁后杰，李建军 ( （400038 重庆，第三军医大学西南医院肿瘤科） [关键词] 辅助化疗；结肠肿瘤 Adjuvant chemotherapy for resectable colon cancer: consensus and disagreement Liang Houjie, Li Jianjun( Department of Oncology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China) [Abstract] Standard surgical treatment for patients with localized colon cancer has been radical resection of the primary and regional lymph nodes. Stage Ⅰ patients do not require any adjuvant therapy after resection. While adjuvant chemotherapy has proven benefit in stage Ⅲ colon cancer, its potential value for stage Ⅱ colon cancer is controversial. At present, 6 months of adjuvant chemotherapy following primary surgical treatment has been recommended as standard care for stage Ⅲ patients. Current evidence does not support the widespread use of adjuvant therapy in stage Ⅱ colon cancer. But for high-risk stage Ⅱ patients, defined as those with poor prognostic features including T4 tumors, poor histologic grade (grade 3 or 4 lesions), lymphovascular invasion, perineural invasion, bowel obstruction, lesions with localized perforation or close, indeterminate, or positive margins, and inadequately sampled nodes (less than 12 lymph nodes), should be considered for adjuvant chemotherapy. Irinotecan and target agents such as bevacizumab, cetuximab, or panitumumab must be avoided in the adjuvant setting. Perioperative regional liver chemotherapy has not been proven to reduce the rate of liver metastases or improve overall survival for resected colon cancer patients. [Key Words] adjuvant chemotherapy; colonic neoplasms Corresponding author: Liang Houjie, Tel: 86-23 E-mail: lianghoujie@ 根据美国1992-2004年130,762例结肠癌（不包括转移性结肠癌）的统计资料，不同分期（AJCC 2010年）的5年生存率分别为：Ⅰ期 97.1%，ⅡA期 87.5%，ⅡB期 79.6%，ⅡC期 58.4%，ⅢA期 87.2%，ⅢB期 64.9%，ⅢC期 32.9%，结果显示分期较早的患者，其疗效并不一定优于分期较晚者，ⅢA期5年生存率明显高于ⅡC期，也高于ⅡB期，与ⅡA期相似，其原因与Ⅲ期患者通常接受术后辅助化疗有关。结肠癌根治性外科切除术后是否进行辅助化疗，目前在Ⅰ期和Ⅲ期患者中已达成共识，即：Ⅰ期不需要辅助化疗，Ⅲ期可从辅助化疗中受益；而对于Ⅱ期结肠癌辅助化疗的价值，既有共识，亦存在争议。 1