新辅助化疗治疗直肠癌的研究现状
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摘要
直肠癌是临床常见的消化道恶性肿瘤,发病率及病死率居第四位。由于早期直肠癌症状不明显,大部分患者发现时已错失手术机会。直肠癌临床常见症状有排便习惯改变、便血、腹泻与便秘交替、局部腹痛等,具有易转移、易复发、预后极差等特点。因此,临床迫切需要新的治疗方法以提高直肠癌患者预后。经国内外研究发现,术前结合新辅助化疗(NAC)有助于手术切除率的提高,并且使患者术后生存率得以提高,但仍有部分直肠癌患者经NAC后未曾获益。如何选择NAC方案并使直肠癌患者在降期,提升局部控制率、保肛率,减少局部复发及提高生存质量等方面受益是目前临床工作者的研究重点。本文就NAC治疗直肠癌的研究现状作如下综述。
Rectal cancer is a common clinical malignant tumor of the digestive tract,and its morbidity and mortality ranks fourth. Because early rectal cancer is not obvious,most patients have missed the opportunity to see surgery. Common clinical symptoms of rectal cancer have changes in bowel habits,blood in the stool,alternating diarrhea and constipation,and local abdominal pain. The disease is characterized by easy metastasis,easy recurrence,and poor prognosis. Therefore,new treatments are urgently needed to improve the prognosis of patients with rectal cancer. According to domestic and international research,preoperative combined with neoadjuvant chemotherapy(NAC)can improve the surgical resection rate and improve the postoperative survival rate,but some patients with rectal cancer have not benefited from NAC. Therefore,how to choose the NAC program and benefit patients with rectal cancer in terms of down-regulation,local control rate,anal sphincter preservation rate,reduction of local recurrence and improvement of quality of life are the focus of current clinicians. This article reviews the current status of research on the treatment of rectal cancer with NAC.
Rectal cancer is a common clinical malignant tumor of the digestive tract,and its morbidity and mortality ranks fourth. Because early rectal cancer is not obvious,most patients have missed the opportunity to see surgery. Common clinical symptoms of rectal cancer have changes in bowel habits,blood in the stool,alternating diarrhea and constipation,and local abdominal pain. The disease is characterized by easy metastasis,easy recurrence,and poor prognosis. Therefore,new treatments are urgently needed to improve the prognosis of patients with rectal cancer. According to domestic and international research,preoperative combined with neoadjuvant chemotherapy(NAC)can improve the surgical resection rate and improve the postoperative survival rate,but some patients with rectal cancer have not benefited from NAC. Therefore,how to choose the NAC program and benefit patients with rectal cancer in terms of down-regulation,local control rate,anal sphincter preservation rate,reduction of local recurrence and improvement of quality of life are the focus of current clinicians. This article reviews the current status of research on the treatment of rectal cancer with NAC.
引文
[1]郭天安,谢丽,赵江,等.中国结直肠癌1988—2009年发病率和死亡率趋势分析[J].中华胃肠外科杂志,2018,21(1):33-40.
[2]付尚志,张佳节,李万平.直肠癌术前新辅助放化疗研究进展[J].临床军医杂志,2015,43(4):409-412.
[3]陈功,万德森.2012V1版NCCN结肠癌指南更新解读[J].中国继续医学教育,2011,3(9):19-21.
[4]廉波,宋纯,李鹏雷.FOLFOX4新辅助化疗方案在老年局限性低位直肠癌中的应用[J].疑难病杂志,2014,13(5):444-447.
[5]满元.奥沙利铂联合氟尿嘧啶治疗结肠癌的效果研究[J].保健医学研究与实践,2016,13(5):55-56、59.
[6]王仲,袁娟.中等剂量卡培他滨在老年转移性结直肠癌序贯化疗中的应用[J].现代肿瘤学,2015,23(3):378-379.
[7]杨进山,齐保聚.XELOX方案与FOLFOX4方案治疗转移性结直肠癌的临床观察[J].现代中西医结合杂志,2012,21(27):39.
[8] XIE Q,WEN F,WEI Y Q,et al. Cost analysis of adjuvant therapy with XELOX or FOLFOX4 for colon cancer[J]. Colorectal Dis,2013,15(8):958-962.
[9]高宗跃,周晓丽.XELOX与FOLFOX4治疗方案对老年转移性结直肠癌序贯化疗的效果[J].中国老年学杂志,2018,38(15):3641-3643.
[10]何盛泉,赖家骏,张涛,等.XELOX方案与FOLFOX方案新辅助化疗对进展期直肠癌患者的疗效比较[J].肿瘤药学,2016,6(1):70-73.
[11] ZHAO Y Y,XUE C,JIANG W,et al. Predictive value of intratumoral microvascular density in patients with advanced non-small cell lung cancer receiving chemotherapy plus bevacizumab[J]. J Thorac Oncol,2012,7(1):71-75.
[12]张轶雯,方罗,钟里科,等.贝伐珠单抗在我院抗肿瘤治疗中的应用分析[J].中国药房,2018,29(16):2252-2256.
[13]王艳华,刘冬兰.贝伐单抗联合伊立替康加希罗达治疗晚期结直肠癌的临床观察[J].实用癌症杂志,2016,31(8):1274-1276.
[14]张凯,刘培培,张伟杰,等.替吉奥胶囊联合奥沙利铂方案加贝伐单抗治疗晚期结直肠癌的临床观察[J].肿瘤防治研究,2014,41(9):1036-1039.
[15]李伟,李威威,宋锐,等.贝伐珠单抗或抗EGFR单抗联合FOLFOX方案治疗晚期转移性结直肠癌的临床研究[J].河北医药,2017,39(8):1237-1239、1242.
[16]宋娟,曾冬竹,张弘,等.贝伐单抗新辅助化疗对直肠癌患者微血管密度的影响[J].现代生物医学进展,2015,15(36):7139-7143.
[17]刘荫华,姚宏伟,高国璇.《NCCN直肠癌临床实践指南》外科原则十年变迁及临床意义[J].中华外科杂志,2015,53(1):68-71.
[18]张帅.CapeOX方案新辅助化疗结合手术治疗不可切除的结直肠癌肝转移的效果分析[J/CD].现代医学与健康研究电子杂志,2018,2(11):54.
[2]付尚志,张佳节,李万平.直肠癌术前新辅助放化疗研究进展[J].临床军医杂志,2015,43(4):409-412.
[3]陈功,万德森.2012V1版NCCN结肠癌指南更新解读[J].中国继续医学教育,2011,3(9):19-21.
[4]廉波,宋纯,李鹏雷.FOLFOX4新辅助化疗方案在老年局限性低位直肠癌中的应用[J].疑难病杂志,2014,13(5):444-447.
[5]满元.奥沙利铂联合氟尿嘧啶治疗结肠癌的效果研究[J].保健医学研究与实践,2016,13(5):55-56、59.
[6]王仲,袁娟.中等剂量卡培他滨在老年转移性结直肠癌序贯化疗中的应用[J].现代肿瘤学,2015,23(3):378-379.
[7]杨进山,齐保聚.XELOX方案与FOLFOX4方案治疗转移性结直肠癌的临床观察[J].现代中西医结合杂志,2012,21(27):39.
[8] XIE Q,WEN F,WEI Y Q,et al. Cost analysis of adjuvant therapy with XELOX or FOLFOX4 for colon cancer[J]. Colorectal Dis,2013,15(8):958-962.
[9]高宗跃,周晓丽.XELOX与FOLFOX4治疗方案对老年转移性结直肠癌序贯化疗的效果[J].中国老年学杂志,2018,38(15):3641-3643.
[10]何盛泉,赖家骏,张涛,等.XELOX方案与FOLFOX方案新辅助化疗对进展期直肠癌患者的疗效比较[J].肿瘤药学,2016,6(1):70-73.
[11] ZHAO Y Y,XUE C,JIANG W,et al. Predictive value of intratumoral microvascular density in patients with advanced non-small cell lung cancer receiving chemotherapy plus bevacizumab[J]. J Thorac Oncol,2012,7(1):71-75.
[12]张轶雯,方罗,钟里科,等.贝伐珠单抗在我院抗肿瘤治疗中的应用分析[J].中国药房,2018,29(16):2252-2256.
[13]王艳华,刘冬兰.贝伐单抗联合伊立替康加希罗达治疗晚期结直肠癌的临床观察[J].实用癌症杂志,2016,31(8):1274-1276.
[14]张凯,刘培培,张伟杰,等.替吉奥胶囊联合奥沙利铂方案加贝伐单抗治疗晚期结直肠癌的临床观察[J].肿瘤防治研究,2014,41(9):1036-1039.
[15]李伟,李威威,宋锐,等.贝伐珠单抗或抗EGFR单抗联合FOLFOX方案治疗晚期转移性结直肠癌的临床研究[J].河北医药,2017,39(8):1237-1239、1242.
[16]宋娟,曾冬竹,张弘,等.贝伐单抗新辅助化疗对直肠癌患者微血管密度的影响[J].现代生物医学进展,2015,15(36):7139-7143.
[17]刘荫华,姚宏伟,高国璇.《NCCN直肠癌临床实践指南》外科原则十年变迁及临床意义[J].中华外科杂志,2015,53(1):68-71.
[18]张帅.CapeOX方案新辅助化疗结合手术治疗不可切除的结直肠癌肝转移的效果分析[J/CD].现代医学与健康研究电子杂志,2018,2(11):54.