Colorectal Cancer Liver Metastasis: Evolving Paradigms and Future Directions.
Colorectal Cancer Liver Metastasis: Evolving Paradigms and Future Directions.
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DOI：
10.1016/j.jcmgh.2017.01.006
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发表时间：
2017-03
影响因子：
7.2
通讯作者：
Mayo SC
中科院分区：
文献类型：
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作者：
Zarour LR;Anand S;Billingsley KG;Bisson WH;Cercek A;Clarke MF;Coussens LM;Gast CE;Geltzeiler CB;Hansen L;Kelley KA;Lopez CD;Rana SR;Ruhl R;Tsikitis VL;Vaccaro GM;Wong MH;Mayo SC
在转移到肝脏的结直肠癌（CRC）患者中，改善结局有几个关键目标，包括早期检测，治疗反应的有效预后指标，以及准确识别复发高风险患者。尽管过去十年开发的新治疗方案提高了生存率，但在为受益最大的患者选择靶向治疗方案方面仍有很大的改进空间。最近，在识别高风险患者队列方面取得了令人兴奋的进展，对全身与局部药物递送到转移性小生境的理解有所改进，液体生物标志物的开发以及肿瘤免疫治疗的巨大进步，所有这些都有望采用新的创新方法来解决检测和治疗CRC向肝脏转移的问题。我们的多学科小组在过去的一年里举办了一个国家的科学研讨会，以审查在这个迅速发展的领域的进展。在此，我们提出了一个讨论的问题所面临的治疗CRC肝转移患者，包括离散的基因签名与预后的关系。我们还讨论了旨在减少肝内复发的最大限度地提高区域和全身治疗的最新进展，回顾了对肿瘤微环境的最新见解，并总结了用于早期检测原发性和复发性疾病的非侵入性多模式生物标志物的进展。随着我们在结直肠肿瘤生物学领域的临床和技术不断进步，我们的目标应该是继续完善预测和预后研究，以减少根治性切除术后的复发，并通过量身定制的多学科癌症治疗方法最大限度地减少对患者的治疗毒性。
In patients with colorectal cancer (CRC) that metastasizes to the liver, there are several key goals for improving outcomes including early detection, effective prognostic indicators of treatment response, and accurate identification of patients at high risk for recurrence. Although new therapeutic regimens developed over the past decade have increased survival, there is substantial room for improvement in selecting targeted treatment regimens for the patients who will derive the most benefit. Recently, there have been exciting developments in identifying high-risk patient cohorts, refinements in the understanding of systemic vs localized drug delivery to metastatic niches, liquid biomarker development, and dramatic advances in tumor immune therapy, all of which promise new and innovative approaches to tackling the problem of detecting and treating the metastatic spread of CRC to the liver. Our multidisciplinary group held a state-of-the-science symposium this past year to review advances in this rapidly evolving field. Herein, we present a discussion around the issues facing treatment of patients with CRC liver metastases, including the relationship of discrete gene signatures with prognosis. We also discuss the latest advances to maximize regional and systemic therapies aimed at decreasing intrahepatic recurrence, review recent insights into the tumor microenvironment, and summarize advances in noninvasive multimodal biomarkers for early detection of primary and recurrent disease. As we continue to advance clinically and technologically in the field of colorectal tumor biology, our goal should be continued refinement of predictive and prognostic studies to decrease recurrence after curative resection and minimize treatment toxicity to patients through a tailored multidisciplinary approach to cancer care.