成都MDT结直肠癌肝转移新进展_培训课件.ppt

结直肠癌肝转移局部处理 * Ito K et al. Cancer J 2010;16:103-110 * HAI CRYSTAL: Resection rates by country No. Pts 106 103 89 85 80 73 64 58 58 54 54 49 32 32 27 10 Resections 4 3 9 2 3 1 6 1 4 7 1 1 5 2 1 1 Country Data on file Resection margin in CRC liver metastases  (n=208) Lordan JT (Guildford). Eur J Surg Oncol 2010;36:47–51 Clear resection margin width does not affect survival 0 20 40 60 80 100 Overall survival (%) Time (months) 0 20 40 60 80 100 120 Involved resection margins R1 and R2 (n=14) Clear margins 1–3 mm (n=48) Clear margins 3 mm (n=176) New definition of resectability R0切缘大于1mm 有足够的肝保存肝功能 两个肝段完整，血流和胆道排泄保存 20-25%肝脏保留，或者化疗患者40%肝脏保留 2013 Curr Oncol;20(3):e255-65 MDT非常重要 内科医生想向外科医生了解 可切除性 ? 手术的时机？ 是否有机会长期生存 外科向内科医生了解 能否将不可切除变成可切除？ 通过新辅助提高治疗效果 预防复发 结直肠癌肝转移切除的预后标志物 * * * * * 获得转化切除的患者预后如何？这是最经典的一项研究 The updated survival analysis of those patients who had primary or secondary resection showed nearly identical—and quite encouraging—results. At 5 years, overall survival was approximately 34%, with 20% remaining alive at 10 years. * * * * 我们再看看靶向药物 西妥昔在这方面的数据比较成熟 Van Cutsem E, et al. ASCO 2007. Abstract 4000; Bokemeyer C, et al. ASCO 2007. Abstract 4035; Cassidy J, et al. ASCO 2007. Abstract 4030; Diaz-Rubio E, et al. J Clin Oncol. 2007;25:4224-4230; Tournigand C, et al. 2006;24:394-400; Giachetti S, et al. 2006;24:3562-3569; Tournigand C, et al. J Clin Oncol. 2004;22:229-237; Falcone A, et al. J Clin Oncol. 2007;25:1670-1676. Bev, bevacizumab; Cet, cetuximab; FOLFIRI, 5-fluorouracil, leucovorin, irinotecan; FOLFOX, 5-fluorouracil, leucovorin, oxaliplatin; FU, 5-fluorouracil; IR, irinotecan; mCRC, metastatic colorectal cancer; NR, not reported; ORR, overall response rate; OX, oxaliplatin. The N016966 study results demonstrated a 1.4-month improvement in progression-free survival with the addition of bevacizumab to XELOX or FOLFOX4. The percentage o