Colorectal cancer
Colorectal cancer
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DOI：
10.1016/s0140-6736(10)60353-4
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发表时间：
2010-03-20
期刊：
影响因子：
168.9
通讯作者：
Starling, Naureen
中科院分区：
文献类型：
--
作者：
Cunningham, David;Atkin, Wendy;Starling, Naureen
在过去的十年中，结直肠癌取得了重大进展。筛查用于在早期阶段识别个体，改善了结果。人们对遗传性结直肠癌的遗传基础有了更多的了解，并确定了有风险的患者。局部疾病患者的手术优化对5年和10年生存率有重大影响。对于直肠癌，识别局部失败风险最大的患者在选择术前放化疗患者时非常重要，这是一种被证明可以改善这些患者结局的策略。严格的术后随访有助于早期识别潜在的可根治的寡转移性疾病，并提高长期生存率。结肠癌和直肠癌的辅助氟嘧啶治疗进一步提高了生存率，III期比II期疾病更有效，目前，基于奥沙利铂的联合化疗通常用于III期疾病，尽管疗效必须与毒性仔细平衡。在II期疾病中，微卫星不稳定性等分子标记可能有助于选择治疗患者。靶向治疗与常规细胞毒性药物的整合扩大了转移性疾病的治疗，从而增加了生存率。然而，生物标志物的开发对于帮助选择可能对治疗有反应的患者至关重要，从而使治疗合理化并改善结局。
Substantial progress has been made in colorectal cancer in the past decade. Screening, used to identify individuals at an early stage, has improved outcome. There is greater understanding of the genetic basis of inherited colorectal cancer and identification of patients at risk. Optimisation of surgery for patients with localised disease has had a major effect on survival at 5 years and 10 years. For rectal cancer, identification of patients at greatest risk of local failure is important in the selection of patients for preoperative chemoradiation, a strategy proven to improve outcomes in these patients. Stringent postoperative follow-up helps the early identification of potentially radically treatable oligometastatic disease and improves long-term survival. Treatment with adjuvant fluoropyrimidine for colon and rectal cancers further improves survival, more so in stage III than in stage II disease, and oxaliplatin-based combination chemotherapy is now routinely used for stage HI disease, although efficacy must be carefully balanced against toxicity. In stage II disease, molecular markers such as microsatellite instability might help select patients for treatment. The integration of targeted treatments with conventional cytotoxic drugs has expanded the treatment of metastatic disease resulting in incremental survival gains. However, biomarker development is essential to aid selection of patients likely to respond to therapy, thereby rationalising treatments and improving outcomes.