文档介绍：C R C辅助疗法新进展
江苏省肿瘤防治研究所
江苏省肿瘤医院
黄富麟
183,000 新发病例
占新发癌症病人13%
致死率45%
占美国癌症死亡人数15%
绝大多数病人接受化学治疗
转移/复发病例接受辅助性化疗± RT治疗
结肠直肠癌: 2004 年美国发病率
Jemal et al Ca Cancer J clin 2004 54; 8-29
Surgery ± CT
初诊断结肠癌病理分级
Stage I: 15%
Stage IV: 20–25%
Stage II: 20–30%
Stage III: 30–40%
Hamilton and Grem. Current Cancer Therapeutics (3rd ed.) 1998
Stage I or A
Stage III or C
Stage IV or D
病灶局限
手术±化疗
手术+ 化疗
化疗
手术
已转移
Stage I I or B
TNM
Duke’s
5-year survival %
Stage I
T1 N0 M0
T2 N0 M0
A
B1
85–95
Stage II
T3 N0 M0
T4 N0 M0
B2
60–80
Stage III
Any T N1–3 M0
C
30–60
Stage IV
Any T any N M1
D
<5
美国联合委员会 结肠直肠癌病期分类
Macdonald JS. CA Cancer J Clin 1999; 49:202-219
手术加辅助治疗模型5年生存率评价
淋巴结 T 低度恶性高度恶性
转移状况 stage S S + AT S S + AT
0 T 3 73 77 65 70
T 4 60 66 51 57
T 1-2 62 75 53 68
1 - 4 T 3 49 65 38 56
T 4 33 51 23 40
T 1-2 39 57 28 46
≥ 5 T 3 24 43 15 32
T 4 11 27 5 17
CRC预后
Stage II: 高危人群
T4
周围神经侵犯
血道转移
淋巴道转移
低分化肿瘤
大肠梗阻
5年 OS
30–40%
Van Cutsem E et al. Eur J Cancer 2002 Jul; 38(11): 1429-36
Stage III CRC TNM 校正分类 (n=50042)
%
%
%
0
10
20
30
40
50
60
70
III A
III B
III C
Node-positive subgroups
Observed 5-year survival (%)
p<
IIIA: T1/2 N1
IIIB: T3/4 N1
IIIC: Any T N2
Greene et al. Ann Surg 2002; 236: 416-21
IIIA: T1/2 N1
辅助疗法: Stage III CRC
3 年 Disease-Free 存活率(%)
80
60
20
40
0
50
65
65
72
surgery
5-FU/LV
1-yr
5-FU/LV
6 month
FOLFOX4
Dendrite cell counts
Mutations:
p53
K-ras
Mad2
Invasion: Depth
Lymphatic
Venous
Perineural
Serosal
Differentiation
Invasive front buddin
DNA ploidy
CEA
Surgical skill
Socioeconomic status
No. of nodes examined
Perforation
Occlusion
Watanabe T et al. NEJM 2001; 344: 1196-206
Multifactorial
Role of many markers unclear
Distal intramural spread
预后影响因素?
CRC筛查和预防
乙状结肠镜检查
结肠镜检查/ GI →> 死亡率 15-35% ↓
Identity CRC families ic screen
Intensified screening
外科预防
钙、硒→预防息肉
COX-2 过表达的息肉状癌→ COX-2 抑制剂试验
辅助:预防息肉
佐剂病: 以Celecoxib-C