【作者】 李波；

【导师】 莫显伟；

【作者基本信息】 广西医科大学 ， 肿瘤学（专业学位）， 2016， 硕士

【摘要】 目的：目前单一的临床研究证实,手术、化疗、放疗、介入治疗和分子靶向药物治疗等都分别对结直肠癌肝转移患者均有获益。但是,关于如何科学的整合这些治疗方法及合理的进行序贯,规范的运用于临床,使结直肠癌肝转移患者从中获益,至今临床上尚未见有明确的文献报道。为此,在多学科管理模式下,将以上多种治疗方法,进行有机整合,多重序贯应用于单组结直肠癌肝转移患者,观察治疗效果,为临床治疗提供借鉴。方法：利用目标值法(Objective Performance Criteria, OPC)在数据库中检索国内外2012年1月前发表的文献数据,查询结直肠癌肝转移患者的3年总生存率中位水平作为目标值。从2012年1月1日开始,收纳在广西医科大学附属肿瘤医院胃肠科住院治疗,符合以下纳入标准的结直肠癌肝转移(CRLM)患者：(1)经电子肠镜检查取组织活检,病理结果确诊为结直肠癌,并行CT或(和)MRI检查发现合并肝脏转移；(2)排除合并其他部位转移,及合并双重瘤、多重瘤；(3)排除曾接受其他非正规治疗及PS评分>2分患者；(4)接受2种或2种以上化疗方案治疗,或接受包括手术、化疗、放疗、介入治疗及靶向药物治疗等治疗方式中的2种或2种以上；(5)临床资料齐全的患者。从第1次住院治疗开始,所有患者均经多学科团队(multidisciplinary team, MDT)评估,讨论制定最佳治疗方案,接受多种方法序贯治疗(包括手术、化疗、放疗、介入治疗、联合分子靶向药物治疗),对所有患者进行全程追踪随访、定期评估,适时调整治疗方案。观察截止日期为2015年6月30日。应用SPSS 16.0统计学软件处理统计数据,采用Kaplan-Meier法描绘生存曲线,计算该组患者1年、2年和3年生存率,与目标值进行对比,根据结果评判治疗效果。结果：2012年1月1日至2015年6月30日,共纳入55例结直肠癌肝转移患者,其中第24个月纳入30例。55例患者均接受化疗,原发病灶切除34例,肝脏转移瘤切除9例,其中6例行同期切除,3例行分期切除；12例仅进行非手术治疗；肝动脉灌注化疗4例,射频消融8例,微波消融5例,放射治疗2例,靶向药物联合一线方案化疗6例。观察期间,有19例患者死亡。9例患者接受根治性治疗,46例患者接受非根治性治疗。平均随访时间约15个月,55例患者1年、2年和3年总生存率分别为85.4%、68.7%、47.4%；46例非根治性治疗患者1年、2年和3年生存率分别为60.3%、38.3%、38.3%。9例根治性治疗患者,1例死亡,8例存活。根据文献检索结果,结直肠癌肝转移患者3年总生存率目标值为37.0%；根治性治疗结直肠癌肝转移患者3年生存率目标值为51.4%。55结直肠癌肝转移患者3年总生存率47.4%,远大于目标值37.0%,接近根治性治疗CRLM总生存率51.4%；非根治性治疗患者3年总生存率为38.3%,亦大于目标值37.0%。由此可知,多学科管理模式下多种方法序贯治疗对结直肠癌肝转移患者可能具有一定疗效。结论：多学科管理模式下多种方法序贯治疗能够在一定程度上提高结直肠癌肝转移患者总生存率：但是,由于本观察组未设立随机对照组,还需要更大样本、多中心的临床随机对照试验进一步验证。更多还原

【Abstract】 Objective:At present, the single clinical research has confirmed that the patients of colorectal cancer with liver metastasis could benefit from surgical resection, chemotherapy, radiotherapy, interventional therapy.and molecular targeted drugs. But how to integrate these treatment modalities and get them into sequential therapy reasonably, apply to the patients of CRLM, prolong the life expectancy of the patients effectively, are still unclear. Something about has not yet been reported in the literature. The aim of this study is to observe the Clinical curative effect of the multiple sequential therapies in colorectal cancer with liver metastasis under the management of Multidisciplinary Team (MDT).Methods:Basing on the objective performance criteria (OPC), we search the published literatures from the data base before July 2012, search for the 3-year overall survival rate, and take the median level as the target value. From January 1,2012,the patients were hospitalized in the Department of Gastrointestinal Surgery, affiliated Cancer Hospital of Guangxi Medical University, who meet the following criteria, (1) All got electronic colonoscopy examination, and diagnosed as colorectal cancer, the results of CT or MRI was found with liver metastasis. (2) Removal of other parts of the merger except liver, and excluded the combination of other different tumors. (3)Excluded the patients who had received other informal treatments and PS scores >2. (4) each had accepted at least 2 chemotherapy regimens, or 2 different treatments, including surgical resection, chemotherapy, radiotherapy, hepatic artery infusion, microwave ablation or radiofrequency ablation and molecular targeted drugs. (5) Patients with complete clinical data. All patients were assessed by multidisciplinary team (MDT) from the beginning, to discuss and make the best treatment plans, and carry out a variety of sequential therapy. All the patients were followed up, assessed and adjusted the treatment regularly. The deadline of observation was June 30,2015.The overall survival (OS) analysis was calculated by using the Kaplan-Meier method, using SPSS16.0 software. Compared the 1-,2- and 3-years overall survival rate with the target value, and evaluated the clinical effect of multiple sequential therapies according to the results.Results:A total of 55 patients of colorectal with liver metastasis were brought into the observation, and 30 patients were included for twenty-fourth months. Each had accepted at least 2 chemotherapy regimens, or 2 different treatments, between January 1,2012 and June 30,2015 in our department. Primary lesion resection was performed in 34 cases,,9 cases underwent curative resection of liver metastases,6 cases for two-stage resection,3 cases for 1-stage resection; 12 cases only accepted non-operative treatment; hepatic artery infusion chemotherapy in 4 cases, radiofrequency ablation in 8 cases,5 cases had microwave ablation, and molecular targeted drug combined with first-line chemotherapy in 6 cases. During the period of observation, there were 19 patients were died,9 patients received radical treatment, the other 46 patients received non-radical treatment. The mean time of follow-up was 15 months. Thel-,2-and 3-year overall survival rate was 85.4%,68.7% and 47.4% of the 55 patients, respectively. The 46 patients who accepted non-radical treatment, the overall survival rate of 1-,2- and 3-year was 60.3%,38.3% and 38.3%, respectively. According to the search of the literatures, the 3-year overall survival rate of patients with colorectal cancer liver metastases was 37.0%, and the 3-year survival rate of patients of CRLM underwent radical resection was 51.4%.The 3-year overall survival rate of the 55 patients was far larger than the target value 37.0%, and close to the radical treatment overall survival rate 51.4%, the 3-years overall survival rate of non-radical treatment of patients was 38.3%, which was a bit greater than the target value of 37.0%. Therefore, it can be confirmed that multiple sequential therapies may has a certain curative effect on liver metastasis of colorectal cancer.Conclusions:The multiple sequential therapies in the modality of management of multi-disciplinary team, may have a certain effect on the patients of CRLM, increasing the overall survival (OS) of CRLM in a certain extent. A further study is needed of a larger sample and multi-centers of randomized controlled trials to verify the result.更多还原