结肠癌术后辅助治疗的研究进展

[e-mail]1500811【】。10。。1/31/4。。、、。【】Ｒ735.3A1009－0460201604－0376－05ProgressofpostoperativeadjuvanttherapyforcoloncancerMEINingzhuoHANYuBAIYuxian．DepartmentofMedicalDigestionCancerHospitalHarbinMedicalU-ni[e-mail]【Abstract】Coloncancerisoneofthemostcommongastrointestinalmalignancy．Inthepastdecadetheadjuvanttherapyofcoloncancerhasmadegreatprogress．Althoughsurgeryisthemainstayoftreatmentincoloncanceradjuvanttreatmentisalsoanim-portantaspectofincreasingdisease-freesurvivalandoverallsurvivalinpatientswithcoloncancer．Inpatientswithcoloncancerwhosufferradicalsurgeryapproximatelyone-thirdofpatientsarewithregionallymphnodemetastasisandone-quarterofpatientsarenotassociatedwithregionallymphnodemetastasisbuttheyhavehighriskfactorsforrecurrence．Theroleofadjuvanttherapyistoelimi-natecancermicrometastasissedimentswhichcanincreasethechanceofcancerrecurrence．Inthisarticlethedurationofchemothera-pyhowdopatientswithdifferentclinicalstagesstartadjuvanttherapyadjuvanttherapyofelderlypatientsandinternationalprevailingdisputesaboutadjuvanttherapyarereviewed．【KeyWords】ColoncancerAdjuvanttherapy。2012140691。。1199220041307625Ⅰ97.1%ⅡA87.5%ⅡB79.6%ⅡC58.4%ⅢA87.2%ⅢB64.9%ⅢC32.9%2。ⅢA5ⅡCⅡAⅢ。2009ACCENT31978199918ⅢⅡ、Ⅲ208985-FU5-FU1～239%87%Ⅱ5%Ⅲ10%。MOSAIC4FOLFOX4FL5-FUⅡ、ⅢFLFOLFOX455.9%Ⅲ7.5%Ⅱ3.8%62.5%Ⅲ4.2%ⅡⅡ1.7%。ⅠⅢⅠⅢ·673·20164214ChineseClinicalOncologyApr．2016Vol．21No．4Ⅱ。22011Biagi54OSDFS。OS。4～6。6。I-DEA6、8500Ⅲ36FOLFOX4/FOLFOX6/XELOX3。201620176。、、。3ⅡⅡ。QUASAＲ7Ⅱ5-FU。5.520%ＲＲ=0.8295%CI0.70～0.95P=0.00822%ＲＲ=0.7895%CI0.69～0.91P=0.0015P＞0.051%～5%。ⅡDFSⅡ。“Ⅱ”3。。19902001MSKCC8448Ⅱ3CEAHＲ=2.195%CI1.1～4.1P=0.02、T4HＲ=2.795%CI1.1～6.2P=0.02、/HＲ=2.195%CI1～4.4P=0.04。595%185%≥257%。2013NCCN“Ⅱ”3/4、/、、、/＜12、、T4ⅡB、ⅡC、、。NCCNⅡ5-FU。Ⅱ。2012Tournigand9MOSAICⅡFLFOLFOX457.7%82.3%vs．74.6%P=0.63。。Ⅱ、18q、、。ⅡMSSMSI-L/pMMＲ5-FUMSI-H/dMMＲ10。Sargent11dMMＲⅡ5-FU515%87%vs．72%P=0.05。ⅡdMMＲ5-FU。pMMＲⅡ5-FU55%72%vs．77%P=0.84。dM-MＲ5-FUdMMＲ5-FUⅡDFS。FLⅡMMＲdMMＲ。。oncotypeDXoncotypeDXQUASAＲFL3。、、Ⅱ322%、18%、12%P=0.0412。。3、。。4ⅢMMＲⅢ。Sinicrope13MMＲⅢ。MSI-HdMMＲ。Klingbiel14MSI-HdMMＲⅢ。。·773·20164214ChineseClinicalOncologyApr．2016Vol．21No．4Ⅲ5-FU5-FUFLOX、FOLFOX、XELOXDFSOS15。MOSAIC4FOLFOX4FLDFSOS。FLFOLFOX4Ⅲ566.4%vs．58.9%P=0.005672.9%vs．68.3%P=0.02320%。ⅢNSABPC-0716FLOX5-FU/LV/5-FU/LVⅡⅢ。5-FU/LVFLOX473.2%vs．67%。OS64%515%P=0.06。25-FU/LV。ⅢNO1696817XELOXMayoⅢ。XELOXMayo566.1%、59.8%P=0.004577.6%、74.2%P=0.149。XELOXⅢDFS。NO16968MO-SAICXELOXFOL-FOX4DFSXELOXFOL-FOX4Ⅲ。XE-LOXFOLFOX4Ⅲ18。CALGB8980319PETACC-3205-FUFOL-FIＲI5-FU。5-FUFOLFIＲI。。EGFＲVEGF。NSABPC-0821FOLFOX6FOLFOX6Ⅱ、Ⅲ35.6375.5%vs．77.4%P=0.15。FOLFOX63、、、。PETACC822FOLFOX4FOLFOX4K-ＲasⅢ。K-ＲasⅢFOLFOX4DFSOS。5-FU。5、、、。Sanoff23Ⅲ。200420075489≥75Ⅲ5-FU324%。5-FU。2009ACCENT246MOSAICNSAB-PC07FOLFOX4FLOX≥7014%16%FLOXFLOXDFSHＲ1.0495%CI0.80～1.35OSHＲ1.1995%CI0.90～1.57。62.57%FLOX1.37%。2012ACCENT≥70TTＲ、DFSOS＜7025。NSABPC-08、XELOXA、X-ACTAVANTⅢ5-FU26。。1XELOXFOLFOXⅡⅢ＞7023≥705-FU。、10500Ⅲ6SCOT、PＲODIGE、CALGB/SWOGC80702、TOSCA、HOＲG、A-CHIEVE。6S-15-FU。ACTS-CC27ⅢUFT/LVS-16372.5%、75.5%76.5%、73.4%314.4%、16.0%·873·20164214ChineseClinicalOncologyApr．2016Vol．21No．4P＞0.05。S-1ⅢⅢJCOG0910。SOXUFT/LVⅢACTSCC02。7ⅣＲ0、、Ｒ0520%～45%28。Ｒ0。Ｒ0ⅣⅣ。Ｒ0Ⅲ29。ⅢEOＲTC4098330Ｒ0FOLFOX4FOLFOX4342.4%vs．33.2%P=0.025。8.5551.2%vs．47.8%。FOLFOX4OS61.354.3。ⅣＲ0。Ychou31FOLFIＲIFLＲ0FOLFI-ＲIFLOS24.721.6P＞0.05。Ⅳ。Turan32FOLFOX4Ｒ0。27FOLFOX4FOLFOX4ＲFSP＞0.05。ⅣＲ0Ⅲ。2012NCCNⅢFOLFOX。10。。。Ⅱ。1TorreLABrayFSiegelＲLetal．Globalcancerstatistics2012J．CACancerJClin201565287－108．2JemalASiegelＲXuJetal．Cancerstatistics2010J．CACancerJClin2010605277－300．3SargentDSobreroAGrotheyAetal．Evidenceforcurebyadju-vanttherapyincoloncancerJ．JClinOncol2009276872－877．4AndréTBoniCMounedji-BoudiafLetal．MulticenterInter-nationalStudyofOxaliplatin/5-Fluorouracil/LeucovorinintheAdjuvantTreatmentofColonCancerMOSAICinvestigators．OxaliplatinfluorouracilandleucovorinasadjuvanttreatmentforcoloncancerJ．NEnglJMed2004350232343－2351．5BiagiJJＲaphaelMJMackillopWJetal．Associationbetweentimetoinitiationofadjuvantchemotherapyandsurvivalincolorec-talcancerasystematicreviewandmeta-analysisJ．JAMA2011305222335－2342．6AndréTIvesonTLabiancaＲetal．TheIDEAInternationalDurationEvaluationofAdjuvantChemotherapycollaborationProspectivecombinedanalysisofphaseⅢtrialsinvestigatingdu-rationofadjuvanttherapywiththeFOLFOXFOLFOX4orModi-fidFOLFOX6orXELOX3versus6monthsregimenforpa-tientswithstageⅢcoloncancerTrialdesignandcurrentstatusJ．CurrColorectalCancerＲep201393261－269．7DotanEBrownerIHurriaAetal．Challengesinthemanage-mentofolderpatientswithcoloncancerJ．JNatlComprCancNetw2012102213－225．8QuahHMChouJFGonenMetal．Identificationofpatientswithhigh-riskstageⅡcoloncancerforadjuvanttherapyJ．DisColon＆Ｒectum2008515503－507．9TournigandCAndréTBonnetainFetal．AdjuvanttherapywithfluorouracilandoxaliplatininstageⅡandelderlypatientsbetweenages70and75yearswithcoloncancersubgroupan-alysesofthemulticenterinternationalstudyofoxaliplatinflu-orouracilandleucovorinintheadjuvanttreatmentofcoloncancertrialJ．JClinOncol201230273353－3360．10MouradovDDomingoEGibbsPetal．Survivali