大腸直腸癌肝轉移的治療

大腸癌合併肝轉移的情況，若診斷時肝轉移病灶為可切除者，則建議手術切除，切除後病患的五年存活率約25~30%左右；另外，若肝轉移病灶診斷時屬不可切除者，則建議以化學治療合併標靶治療數次，使腫瘤得以縮小，文獻記載術前的積極化學治療可使20%病患的肝轉移病灶變成可切除，而目前法國Adam等人的報告，經術前化學治療所促成之次級可切除肝轉移病患，其5年存活率與初級可切除之肝轉移病患的5年存活率差不多（亦為30%左右）。然而，吾人以為經化學治療藥物治療後變為可切除之肝轉移病灶，外科切除的角色仍未明，因缺乏足夠的數據顯示外科切除會比保守療法或射頻治療等其他非手術療法更佳。繼續尋找大腸直腸癌肝轉移病灶化學治療的分子標靶，以及進一步針對次級可切除肝轉移病灶關於手術切除及射頻治療的利弊得失的隨機前瞻性研究仍是必須的。

關鍵字

大腸直腸癌；肝臟轉移；手術；化學治療

並列摘要

For hepatic metastasis from colorectal cancer, if the hepatic metastases are resectable at the initial diagnosis, aggressive surgical resection is recommended and it can achieve 5-year survival of approximately 25~30% for patients; whereas for initially unresectable hepatic metastases, neoadjuvant therapy with chemotherapeutic plus targeted agents is recommended. According to the reports from Adam et al., preoperative neoadjuvant therapy can downsize the hepatic metastases and convert approximately 20% of unresectable hepatic metastases into resectable ones and achieve 5-year survival rate of 30%, which is equivalent to that of initially resectable hepatic metastases. However, we feel that the role of surgery in the treatment of the subsets of patients with secondary hepatic metastases from colorectal cancer remain ambiguous, because currently randomized prospective clinical trials comparing surgical and various non-surgical treatment modalities (e.g. radiofrequency ablation ) are not available. Further research should be focus on the design of various randomized trials and looking for molecular markers to facilitate individualized therapy for patients with hepatic metastases from colorectal cancer.

並列關鍵字

colorectal cancer ； hepatic metastasis ； surgery ； chemotherapy

國際替代計量

大腸直腸癌肝轉移的治療

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