西妥昔单抗转化性治疗大肠癌肝转移患者的临床观察

目的观察西妥昔单抗联合化疗转化性治疗初始不可切除KRAS基因野生型结直肠癌肝转移患者的疗效及安全性，探讨与预后可能相关的因素。方法收集2007年5月-2012年5月我院仅有肝转移的KRAS野生型结直肠癌患者，外科评估无法行手术治疗，经西妥昔单抗联合化疗转化治疗后疗效评价为CR＋PR＋SD，并接受原发肿瘤病灶根治术，同时行或不行转移灶手术治疗的患者18例。总结评估其转化治疗疗效和安全性，回顾性分析各临床病理因素与预后关系。结果西妥昔单抗中位治疗时间12周，其中CR0例，PR11例。18例经过转化性治疗后，均接受了手术治疗，原发灶切缘无癌细胞（RO）切除18例；肝转移病灶RO切除11例，局部治疗7例。生存分析显示：18例中，12例出现复发转移，5例死亡。中位无进展生存期（progression free survival，PFS）为20．80个月，总生存时间（overall survival，OS）为9．59～37．13个月。单因素分析显示：肝转移病灶数目、大小、治疗前的CEA状态、治疗后早期肿瘤缓解与患者PFS相关，差异有统计学意义（P〈0．05）。结论对于KRAS野生型大肠癌肝转移患者，西妥昔单抗联合多种化疗方案转化性治疗安全有效，提高了肝转移灶RO切除率，使其生存获益。

Clinical observation of cetuximab in conversion therapy of patients with unresectable colorectal liver-limited metastases

Objective To investigate the efficacy and safety of cetuximab combined with chemotherapy for patients with KRAS Wild-Type unresectable colorectal liver-limited metastases and explore the factors that may affect the prognosis. Methods Clinical data of 18 patients with KRAS Wild-Type unresectable colorectal liver-limited metastases admitted to our hospital from May 2007 to May 2012 were collected and all patients were treated with cetuximab combined with chemotherapy with the efficacy evaluating as CR＋PR＋SD. Then they accepted lesion resection of the primary tumor, and simultaneously accepted lesion resection of the metastases partially. The efficacy and safety of conversion therapy were summarized and assessed, and the relationship between clinicopathology features and outcome were retrospectively analyzed. Results The median duration treatment of cetuximab was 12 weeks, with CR in 0 case, PR in l 1 cases. All patients received surgery after conversion therapy, 11 of them underwent synchronous radical colorectal surgery and liver metastases resection, 7 of them received local treatment of metastases. In the 18 patients, recurrent metastases occurred in 12 cases and death in 5 cases. Median PFS 37.13 months. Univariate analysis showed that the number, size （progression-free survival） was 20.8 months, and the OS was 9.59 - and location of liver metastases, serum CEA concentration, early tumor response were related to the PFS with significant differences （P 〈 0.05）. Conclusion Cetuximab combined chemotherapy can improve R0 resection rate of the primary tumor and metastases with efficacy and safeness for paients with KRAS Wild-Type unresectable colorectal liver-limited metastases.