转移性结直肠癌 课件.pptVIP

研究发现影响预后不良的因素还有：原发灶的淋巴结转移，同时性或异时性的多个肿瘤，肝脏多叶累犯，CEA高于200ng/mL。 但这些研究结果本身并没有排除长期生存的可能性。 Recurrence after hepatectomy for colorectal metastases is?common, occurring in more than two-thirds of patients. In?fact, long-term survival does not necessarily imply that there?has been no recurrence. In patients who do recur, the?liver is the most common site of recurrence and is involved?approximately 45% of the time. Most of these recurrences are?isolated to the liver. Other common sites are lung, bone, and?various intra-abdominal sites. Repeat hepatectomy for?metastatic colorectal cancer is safe and effective in well-selected patients. Mortality is less than 5%, median survival?from the time of the second liver resection ranges from 23 to?46 months, and 5-year survival ranges from 30% to 41%.? 肝切除后的复发也很普遍，大约2/3. 对于复发的患者，肝脏还是最常见的部位，45%。另外就是肺部、骨及腹腔内。 再次肝切除是安全有效的，但是对适应症的选择是严格的。死亡率不足5%，二次手术后的中位生存时间在23-46个月，5年生存率在30-41%。 The factors most often associated with a poor outcome after?repeat hepatectomy are size and number of tumors, as well as?short DFI. 影响二次手术预后的因素有复发病灶的大小、数量、间隔时间。 With the?advent of more effective systemic chemotherapy, such as?irinotecan and oxaliplatin, as well as molecular targeted agents,?new trials are needed to assess optimal adjuvant therapy.?Because the majority of patients with hepatic colorectal?metastases are technically unresectable, the development of?more effective chemotherapy has inspired many oncologists to?use a “neoadjuvant” chemotherapy strategy in an attempt to?render patients resectable. These early studies suggest that?patients with unresectable liver metastases should be treated?aggressively with chemotherapy and reevaluated at intervals?for the possibility of resection. 大多数结直肠癌肝转移患者的肝转移灶都是不可切除的，这也促使肿瘤学家研究更为有效的新辅助化疗方法以期从不可切除转化为可切除。 所以对于不能切除的肝转移癌应积极化疗并不断的评估是否存在切除的可能。 Although resection has become the gold standard for treatment of liver metastases, other methods of tumor destruction?using thermal ablation techniques have also been developed.