结直肠癌及结直肠癌肝转移流行病学特点

目的 分析结直肠癌(CRC)流行病学特征及同时性结直肠肝转移(synCRLM)的影响因素,更好为CRC的预防、诊断、治疗和预后判断提供指导和依据.方法 以"结直肠肿瘤、肝转移、同时性、流行病学、危险因素"作为中文关键词,以"colorectal neoplasms、liver metastases、synchronou...     

结直肠癌相关基因甲基化研究现状和进展

目的：回顾和总结国内外对结直肠癌相关基因甲基化异常改变的研究及其进展。方法：应用Medline及CNKI期刊全文数据库检索系统,以“结直肠癌、甲基化以及结直肠癌相关基因（如K-ras、p53、c-myc、APC、p16、RASSF1A、hMLH1和ERβ）”等为关键词,检索197901～2008—01结直肠癌相关基因甲基化研究的相关文献。纳入标准：1）结直肠癌与甲基化异常改变;2）结直肠癌相关基因。最后纳入35篇文献。结果：在结直肠癌组织中,K-ras和p53基因的异常改变以点突变为主;c-myc基因局部低甲基化是结直肠癌发生中的早期事件,与细胞增殖密切;APC基因除了杂合性丢失（LOH）致失活外,启动子异常高甲基化致失活也很常见;结直肠癌组织呈现一个不定的甲基化分布密度（所有CpG岛中甲基化CV-G占的比例）则可能是p16基因启动子甲基化模式在体内的特征;RASSF1A基因主要因启动子甲基化而失活;hMLH1失活引起MSI（＋）表型可能与右侧散发性结肠癌的分期有密切的关系;ERβ甲基化模式的分析对判断肿瘤预后有价值。结论：因不同基因而异,除了DNA点突变、缺失、插入和重排等遗传学改变外,甲基化等表观遗传学改变在结直肠癌发生中也占重要地位;甲基化研究对结直肠癌的防治将起到积极的探索意义。     

结直肠癌的新辅助治疗

新辅助治疗在提高可切除性结直肠癌患者的手术率和生存率方面取得一些可喜结果。以奥沙利铂、依立替康为基础联合化疗,在提高转移性结直肠癌患者手术率与生存率疗效已较为肯定。肝动脉介入治疗(如HAI、TACE等)在新辅助治疗中的应用疗效有待进一步研究。术前PVE和两步肝切除术可提高手术安全性和切除率。     

结直肠癌转移的防治进展

结直肠癌（colorectal carcinoma,CRC）是全球发病率第3位、死亡率第4位的恶性肿瘤,每年新发病例数100~200万并导致60万人死亡[1]。在一些低危险性国家,比如西班牙、部分东欧及东亚国家,结直肠癌的发病率在快速的增高,这种情况被归因于膳食模式的改变以及逐渐西方化的生活方式。在美国以及其他一些高收入国家,由于乙状结肠镜和全结肠镜息肉切除术的应用增加,     

糖尿病与结直肠癌发病及转移关系

[目的]了解糖尿病与结直肠癌发病及其转移的关系。[方法]采用病例对照的方法分析我院364例结直肠癌患者和非肿瘤患者733例与糖尿病的关系。[结果]糖尿病患者患结直肠癌的危险度是非糖尿病患者的1.72倍;有糖尿病史的结直肠癌患者发生转移的危险度是无糖尿病史的1.94倍;多因素Logistic回归分析显示：糖尿病史是结直肠癌患病的独立危险因素。[结论]糖尿病增加了患结直肠癌的风险性,并可加速结直肠癌的转移。     

结直肠癌化疗的研究进展

目的:对结直肠癌(CRC)化疗的新进展进行综述分析.方法:应用PubMed、CNKI数据库和ASCO论文集等检索系统,以“结肿瘤、直肠肿瘤和化疗”为检索词,检索2005-01-2012-06的相关文献,共检索到英文文献303篇,中文文献78篇.文献纳入标准:1)结直肠肿瘤;2)药物治疗;3)大型的随机对照临床试验;4)排除单中心、小样本试验结果.根据纳入标准符合分析文献31篇.结果:CRC的辅助化疗、新辅助化疗、转移性CRC的化疗及靶向治疗方面均取得了显著进展.随着新一代化疗药物的出现,奥沙利铂、氟尿嘧啶、伊立替康、希罗达及分子靶向药物西妥昔单抗、贝伐单抗等组成的多种化疗方案使得CRC患者的生存期、无病生存期及缓解率得到了明显改善,毒副作用进一步降低.结论:CRC的化疗向着规范化及基于分子靶向的个体化治疗方向发展,终将使患者更好的临床获益.     

化学预防治疗结直肠癌进展

结直肠癌是一种可以预防的疾病,如普查可以早期发现腺瘤性息肉,息肉摘除术可以治愈早期癌肿。随着对结直肠癌变机制的了解,正常上皮至癌的发生过程可以得到干预,从而预防癌肿的发生。化学预防(chemoprevention)是指利用合成或自然存在的化合物去预防腺瘤性息肉等癌前病     

结直肠癌流行趋势及其对策

结直肠癌的发病率和死亡率在全球仍呈上升趋势。预测2007年新病例接近120万,死亡63万,分别比2000年增加27％和28％,平均年增加3．9％和4．0％。结直肠癌有明显的地域分布差异性,随时间推移,这种差异性又发生了变化。原来高发地区结直肠癌发病有3种趋向：继续逐渐上升,如英国：稳定无大变化,如新西兰;下降,如美国、西欧等。原来低发区近年结直肠癌发病率不断攀升,例如亚洲的日本、中国香港、新加坡,东欧的匈牙利、波兰、以色列,拉美国家如波多黎各,特别是日本发病率上升最快。中国也不例外,结直肠癌发病率年增加4．2％（以上海为例）,比全球平均递增速度还高;1991年以来结直肠癌死亡率年均增加4．7％。女性发病比例增加和发病部位右移也是近年结直肠癌流行的趋势。结直肠癌是由环境、饮食以及生活方式与遗传因素协同作用的结果。通过防癌健康教育,使人们养成良好的生活习惯、合理安排饮食、积极参与筛查和去除癌前病变,能有效地预防结直肠癌的发生。     

结直肠癌转移的预防与治疗研究新进展：肝转移性结直肠癌治疗策略进展

在男性和女性患者中,结直肠癌均为第3位常见癌症[1]。尽管结直肠癌的诊断与治疗水平不断提高,仍有15%~25%被诊断时即为转移性结直肠癌[2];且即便进行根治手术仍有50%将发展为转移性疾病[3]。转移性肿瘤患者的5年生存率仅为8%。肝转移是结直肠癌最常见的转移途径,也是影响结直肠癌患者术后生存的主要因素,约有30%的结直肠晚期肿瘤患者死于肝脏转移[4]。     

Chronic ulcerative colitis and colorectal cancer

One of the most important consequences of chronically active ulcerative colitis (UC) or Crohn’s disease (CD) – the two major forms of inflammatory bowel disease (IBD) – is the development of colorectal cancer (CRC). An increased risk for the occurrence of CRC in up to 30% of affected patients after 35 years of UC has been reported. Recent evidence from population based studies indicates a lower risk. Nevertheless the incidence is still significantly increased as compared to individuals without chronic colitis. Colitis-associated CRC (CAC) does not display the adenoma-carcinoma sequence which is typical for sporadic CRC and the pathophysiology appears to be different. Chronic inflammation and the increased turnover of epithelial cells contribute to the development of low- and high-grade dysplasia which may further transform into CAC. Reactive oxygen species (ROS) generated by the inflammatory infiltrate are thought to contribute to the generation of dysplastic lesions. In sporadic CRC the sequence of mutations that finally lead to malignancy involves early activation of Wnt/β-catenin pathway (in 90% of cases) including mutations in adenomatous polyposis coli (APC) tumor suppressor gene, its regulating kinase GSK3β and β-catenin itself. β-catenin mutations are rarer in CAC and mutations in APC occur rather late during the disease progression, whereas there are earlier mutations in p53 and K-ras. Recent data indicate that the intestinal microbiome and its interaction with a functionally impaired mucosal barrier may also play a role in CAC development. CACs frequently show aggressive growth and early metastases. The treatment of CAC in patients with colitis always includes proctocolectomy with ileoanal anastomosis as meta- or synchronic lesions are frequent.     

Progress in chemotherapy for colorectal cancer

Among colorectal cancer patients with recurrent or metastatic sites, survival was significantly prolonged for a group undergoing LV/5-FU therapy based on biochemical modulation compared with a group receiving no chemotherapy (best supportive care). LV/5-FU combination therapy is recognized as the standard therapy for colorectal cancer, but recently LV/5-FU plus oxaliplatin and LV/5-FU plus CPT-11 have appeared to be more effective than LV/5-FU in some randomized studies. Capecitabine, UFT/LV and S-1 are new oral drugs that are at least comparable to LV/5-FU in antitumor activity, but superior in tolerability, which benefits the patients' quality of life, especially elderly patients with colorectal cancer. Clinical combination studies using CDDP or CPT-11 with these oral drugs are now being performed. Much is expected of these drugs.     

Folate and prevention of colorectal cancer in ulcerative colitis.

Patients with ulcerative colitis are at greater risk of developing colorectal cancer than the general population. Prophylactic colectomy is the only certain method of avoiding this risk. To avoid indiscriminate surgery, efforts have focused on colonoscopic surveillance in order to select for prophylactic surgery only patients at ultra-high risk. However this policy has not always been proven to reduce mortality for colorectal cancer in these patients. Recently, there has been growing interest in chemoprevention using folate. Folate maintains the normal DNA methylation process and steady-state levels of DNA precursors. These properties indicate that folate has potential as chemopreventive agent.     

转移性结直肠癌分子靶向治疗临床研究进展

 转移性结直肠癌应用最多的靶向药物包括贝伐珠单抗和西妥昔单抗。贝伐珠单抗和西妥昔单抗均是单克隆抗体,作用靶点分别为血管内皮生长因子（VEGF）和表皮生长因子受体（EGFR）。在转移性结直肠癌,无论是一线还是二线治疗,靶向药物联合化疗均可增加疗效,延长患者的生存。靶向药物联合化疗增加肝转移灶的切除率。k-ras基因突变是西妥昔单抗的疗效预测因子。对于贝伐珠单抗目前尚无明确的疗效预测因子。     

Progress in adjuvant therapy for colorectal cancer

The progress and role of adjuvant therapy for resectable colorectal cancers are reviewed herein. 5-FU/leucovorin is considered the standard treatment in the postoperative adjuvant chemotherapy for Dukes'C colon cancer. The oral 5-FU prodrugs, such as UFT and capecitabine, will replace 5-FU infusion in the adjuvant chemotherapy in the near future. In Dukes'B colon cancer, the results of postoperative adjuvant chemotherapy are controversial. Many randomized trials in the USA and Europe have demonstrated that pre- or postoperative radiation therapy for rectal cancer decreases local recurrences but has no additional benefit on survival compared with 5-FU-based adjuvant chemotherapy. Adjuvant radiation therapy for rectal cancer is not widely used in Japan, while chemotherapy is considered the adjuvant treatment of choice. The local recurrences of rectal cancer is a surgeon-related phenomenon: the surgical technique used and the skill of the surgeon are major factors influencing outcome.     

晚期大肠癌化学治疗进展

全身化疗能控制晚期大肠癌症状，延长生存时间，提高生活质量。5-氟尿嘧啶(5-FU)仍是大肠癌治疗的基本药物，其生化调节化疗方案优于单纯5-FU治疗，含有依林特肯或草酸铂的5-FU联合化疗已成为晚期大肠癌新的标准治疗方案；口服希罗达已证实至少能取得与静脉注射5-FU相同的疗效，但最佳化疗方案、给药方式仍有争论。     

大肠癌基因治疗进展

大肠癌基因治疗是研究热点之一,主要包括免疫分子基因治疗、自杀基因治疗、基因缺陷纠正、抑制肿瘤血管生成基因治疗和病毒基因转导溶解肿瘤细胞等方法。现综述以上几种大肠癌基因治疗方法的研究现状和进展。     

结直肠癌治疗进展

结直肠癌是常见的消化道恶性肿瘤,其发病率和死亡率均居恶性肿瘤前五位,多数患者确诊时已是中晚期。近年来,随着研究的广泛和深入、早期诊断技术的进步、新辅助治疗理念发展、分子靶向药物的开发应用,结直肠癌的综合治疗也朝着更加规范化、个体化和精准化方向发展,结直肠癌的5年生存率稳步提高。本文就国内外结直肠癌治疗的最新进展作一述评。     

结直肠癌内科治疗进展

结直肠癌是最常见的恶性肿瘤之一.新的化疗药物和分子靶向药物的问世,使晚期结直肠癌病人中位生存期延长,根治术后的辅助治疗使Ⅲ期结肠癌病人复发和死亡风险进一步降低.本文综述结直肠癌内科治疗最新进展.