新辅助化疗方案在可切除结肠癌中的应用进展

新辅助化疗（NACT）是指针对潜在可根治切除的肿瘤患者，以消除微转移、降低肿瘤分期和手术难度、改善术后局部复发和远处转移等为目的，在肿瘤手术切除或放疗之前，先予以全身化疗，待手术或放疗之后继续完成全程化疗的综合方案。结肠癌是最常见的癌症之一，肿瘤根治性切除联合术后辅助化疗是临床潜在可根治切除结肠癌的主要治疗方式。虽然这种治疗模式较前显著改善了患者的预后，但术后局部复发和远处转移仍是患者最主要的致死因素。近年来NACT方案开始被引入局部进展期结肠癌和原发灶可切除的肝转移患者等潜在可根治切除结肠癌患者的治疗。然而，结肠癌患者是否适合NACT及其方案的选择还存在较大的争议。笔者就局部进展期结肠癌、可切除结肠癌肝转移等在NACT中的进展与争议，以及影像学检查对NACT的作用作一综述。

Progress of application of neoadjuvant chemotherapy in resectable colon cancer

Neoadjuvant chemotherapy (NACT) refers to a comprehensive treatment plan for patients with potentially resectable tumors by performing systemic chemotherapy before tumor resection or radiotherapy, and then continuing to complete the whole course of chemotherapy after surgery or radiotherapy, with the aim of eliminating micrometastases, tumor downstaging and reducing surgical difficulty. Colon cancer is one of the most common cancers, and radical tumor resection combined with postoperative adjuvant chemotherapy is the main treatment for potentially curable colon cancer. Although this treatment mode has significantly improved the prognosis of patients, postoperative local recurrence and distant metastasis are still the main causes of death. In recent years, NACT has been introduced as a treatment option for potentially curable colon cancer patients such as those with locally advanced colon cancer or with liver metastases and resectable primary tumor. However, there is still a significant controversy regarding whether colon cancer patients are suitable for NACT and the choice of NACT regimens. Here, the authors address the progress and controversies of NACT in locally advanced colon cancer and resectable colon cancer liver metastasis, as well as the role of imaging examinations in NACT.