[中美大肠癌多学科综合治疗研讨会]邓艳红教授:结直肠癌腹膜转移处理和展望

2017-11-08 佚名 ioncology

2017年11月3日-4日,第八届中美大肠癌多学科综合治疗研讨会暨国家继教育大肠癌高级诊治学习班于上海举行。本次大会由上海市抗癌协会、中国抗癌协会大肠癌专业委员会以及复旦大学大肠癌诊治中心联合举办。中美欧专家在大肠癌的诊断、外科治疗、放疗和影像学领域进行了广泛的经验交流和深入探讨,《肿瘤瞭望》有幸邀请到了中山大学附属第六医院邓艳红教授就结直肠癌腹膜转移患者的多学科治疗以及腹腔热灌注化疗等问题进行了

2017年11月3日-4日,第八届中美大肠癌多学科综合治疗研讨会暨国家继教育大肠癌高级诊治学习班于上海举行。本次大会由上海市抗癌协会、中国抗癌协会大肠癌专业委员会以及复旦大学大肠癌诊治中心联合举办。中美欧专家在大肠癌的诊断、外科治疗、放疗和影像学领域进行了广泛的经验交流和深入探讨,《肿瘤瞭望》有幸邀请到了中山大学附属第六医院邓艳红教授就结直肠癌腹膜转移患者的多学科治疗以及腹腔热灌注化疗等问题进行了分析。

结直肠癌腹膜转移的概述

邓艳红教授:近年来肿瘤界对腹膜转移领域的关注度越来越高。例如,在AJCC第八版的TNM分期把腹膜转移的患者采用特别编号M1c进行标注,这是为了提示临床肿瘤专家区别对待这一部分患者。结直肠癌腹膜转移患者预后有可能显着会比其他部位转移患者预后更差一些,更加引起临床肿瘤专家的关注,针对这部分患者的整体治疗也比较棘手,可能与腹膜转移肿瘤的血供往往不是特别的丰富有关,大部分全身性治疗药物很难到达局部导致患者对化疗不敏感。近几年,临床肿瘤专家发现腹膜转移可能还可以进行再细化,而多学科治疗可能会起到比较重要的作用,腹膜转移应按程度进行细分,类似肝转移细分为单发转移和多发转移。针对腹膜转移的细分也有,美国Sugenbaker教授提出:按照区域把腹腔进行13分法,通过对肿瘤转移累及的区域以及每个区域肿瘤的大小进行评分得出腹膜转移指数评分(PCI),通常认为评分低于12分的患者采用多学科综合治疗可能意义非常重大,可以联合化疗、手术治疗和腹腔热灌注化疗等治疗手段,最后可能使部分患者达到与肝脏局限性转移患者类似的长期生存的效果,但是,评分在25分以上的患者基本上属于临床上预后特别差的患者,针对这类患者是否采用减瘤或者热灌注治疗还有较大的争议。

结直肠癌腹膜转移的高危因素

目前,结直肠癌腹膜转移的高危因素比较明确。第一、原发肿瘤如果突破了浆膜层,即T4a、T4b患者是腹膜转移的高危因素,肿瘤已经突破了脏层的腹膜,肿瘤细胞游离到腹腔中易发生种植转移。第二、右半肿瘤如升结肠、横结肠是腹膜转移的高危因素。第三、从病理类型来讲,粘液腺癌和印戒细胞癌这两种病理类型也更容易发生腹膜转移。第四、N2b以上的多发淋巴结的转移数量较多、切除过程中淋巴管的癌细胞脱离风险高,也是腹膜转移的高危因素。

腹腔热灌注化疗治疗进展

邓艳红教授:腹腔热灌注化疗已经成为热门话题,它的进展还没有明确定论,只能称之为研究的需求,例如很多的外科医生可能都会同意针对T4a或者T4b腹膜转移等风险较高的患者采用预防性腹腔热灌注化疗的观点,但是目前腹腔热灌注化疗的循证医学证据还不是非常充分,需要在全世界范围内开展更多的临床研究进行验证,现在临床肿瘤专家倾向于共识性的做法是针对高危患者采用腹腔热灌注化疗进行预防,可能患者有一定获益。另外,针对具有手术适应症的患者可以采用手术治疗配合腹腔热灌注的化疗可能会进一步提高疾病控制率(dcr),因为全身化疗药物较难到达局部,如果在有效的局部区域进行化疗可以使局部药物的浓度比较高,从而达到提高疗效的作用,而且本身加热与化疗之间也有协同作用以及热效应本身也具有一定的杀灭作用。

结直肠癌腹膜转移领域日益受关注

邓艳红教授:本次会议设置了直肠癌腹膜转移治疗的讨论专场,主要从三个角度来进行探讨:第一、从外科的角度来讲腹膜转移的治疗要点以及治疗原则。第二、从腹腔热灌注化疗疗效角度进行讨论。第三、针对没有热灌注的机会的患者采用单纯腹腔的化疗疗效的探讨。以上几个话题设置得非常好,围绕着多学科综合治疗进行探讨,体现了结直肠癌腹膜转移领域受到越来越多专家的关注。

专家简介:
邓艳红
中山大学附属第六医院肿瘤内科主任、广东省医学会肿瘤学分会委员生物标记学组副组长、美国临床肿瘤协会(ASCO)会员、中国临床肿瘤协会(CSCO)青年沙龙专家成员、广东省抗癌协会化疗专业委员会委员、广州市化疗专业委员会常委。

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    2017-11-10 kcb069
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    2017-11-10 xuyong530

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AI在医疗领域有着广泛的应用前景。日本昭和大学(Showa University)的研究人员表示,AI诊断结肠直肠癌的准确率高达86%,相当不错。

GUT:贝伐单抗治疗肝转移的结直肠癌患者疗效如何?

近期,一项发表在杂志GUT上的研究旨在验证对于不能手术切除的结直肠癌肝转移(CLM)患者,予以贝伐单抗化疗后对患者CT早期最佳形态学应答的预后价值。此外,还评估了基于大小的预后价值以及最佳形态学响应与接受贝伐单抗治疗之间的相关性。此项研究为回顾性研究,研究者们分析了141名首先使用贝伐单抗治疗的患者和142名以奥沙利铂为基础的化疗后添加贝伐单抗治疗的患者。放射科医师使用形态学应答标准评估治疗前和治

JAMA Oncology:摄入纤维与结直肠癌患者生存的关系

尽管膳食纤维摄入增加与结直肠癌发病率降低有关,但是纤维是否会影响结直肠癌患者远期生存是缺乏研究。JAMA Oncology近期发表了一篇文章,研究结直肠癌确诊后纤维摄入与患者死亡之间的关系。

Sci Rep:小豆蔻蛋白可有效抑制结直肠癌细胞的生长

目前结直肠癌是导致癌症死亡的第三大原因。使用饮食干预策略预防包括癌症在内的慢性病引起了研究人员的广泛关注。小豆蔻蛋白是一种香料衍生的营养品,本研究中,研究人员首次评估小豆蔻酸在Azoxymethane(AOM)诱导的结直肠癌小鼠模型中的治疗益处。将小鼠分成4组,其中三组每六周注射一次AOM。一组作为未处理的对照组,其余组从第一次AOM注射后的同一天或第16周开始用载体或豆蔻宁处理。结果发现,小豆蔻

UEGW 2017:研究支持自45岁起实施结直肠癌肠镜筛查

根据正在西班牙巴塞罗那举行的2017年欧洲消化疾病周(UEGW 2017)上公布的一项最新研究显示,从45岁开始而非50岁开始进行结肠镜筛查息肉和腺瘤的检出率将翻倍,无论是否存在息肉或癌症个人史或家族史。