晚期结直肠癌治疗及临床特点

目的:观察晚期结直肠癌一线治疗疗效及临床特征。方法:回顾性分析我科收治的159例晚期结直肠癌患者的临床资料。所有患者采用FOLFOX6/FOLFIRI方案进行一线化疗，观察一线治疗近期疗效及毒副反应。同时对159例晚期结直肠癌发生部位、转移部位、左右半结肠预后情况等进行临床观察分析。结果:我科晚期结直肠癌一线治疗有效率及PFS分别为49.1%，6.73个月。FOLFOX6组与FOLFIRI组有效率（50.0% vs 48.0%)和无进展生存期(6.41个月 vs 7.09个月）差异无统计学意义(P>0.05)；FOLFOX6组毒副反应主要为末梢神经感觉异常。而FOLFIRI组为迟发性腹泻。左半结肠、右半结肠在治疗有效率RR方面（75.0% vs 22.2%，P<0.05），差异有统计学意义。大肠癌的好发部位依次为直肠（60.4%）、左半结肠（22.6%）、右半结肠（17.0%）。晚期结直肠癌转易转移部位依次为肝（50.94%）、肺（40.25%）、骨（24.53%），其中脑转移占3.77%。直肠癌与结肠癌肺转移率分别为（76.67% vs 30.00%），差异具有显著意义(P<0.05)。直肠癌与结肠癌骨转移分别占（76.92% vs 23.08%），差异具有显著意义(P<0.05)。结论:FOLFOX6方案与FOLFIRI方案治疗晚期结直肠癌疗效确切，两组近期疗效相似，均可作为晚期结直肠癌一线治疗，毒副反应可以耐受。大肠癌好发部位以直肠为主，区别于西方。晚期结直肠癌易转移部位依次为肝、肺、骨，且肺、骨转移多见于直肠癌，大肠癌脑转移逐渐增多。同时发现右半结肠癌较左半结肠癌疗效差，左、右半结肠应看做不同的器官。

Clinical characteristics and treatment of advanced colorectal cancer

Objective:To observe the first -line treatment efficacy of metastatic colorectal cancer and clinical fea-tures.Methods:Retrospectivly analyze the clinical data of patients with advanced colorectal cancer who were cured in our department.All patients were divided into FOLFOX6(n =84)/FOLFIRI(n =75)groups.The first -line clinical efficacy and adverse drug reactions in two groups were recorded and compared.To observe colorectal cancer location, transfer area,left/right half colon prognosis.Results:The first -line treatment effective rate and PFS of metastatic colorectal was respectively(49.1%,6.73 months).The overall response rate(50.0% vs 48.0%)and progression -free surial(PFS)(6.41 months vs 7.09 months)of FOLFOX6 group was similar to FOLFIRI group,had no statistical significance.The mainly adverse reaction of FOLFOX6 group was peripheral nerve paresthesia,but FOLFIRI group was delayed diarrhea.The different response rate of left colon cancer and right colon cancer was statistically significant (75.0% vs 22.2%,P <0.05).Predilection sites of colorectal cancer so as rectal(60.4%),left colon(22.6%), right colon(17.0%)successively.The easily transfer position of advanced colorectal cancer was liver(50.94%),lung (40.25%)and bone(24.53%).Brain metastasis accounted for(3.77%).The lung metastasis rate of rectal cancer and colon cancer respectively was(76.67% vs 30.00%),the difference was significant(P <0.05).Bone metastasis of rectal cancer and colon cancer were accounted respectively for(76.92% vs 23.08%)the difference was significant (P <0.05).Conclusion:FOLFOX6 and FOLFIRI plan was curative treatment for advanced colorectal cancer,and the two groups have similar effective rate.Both can be used as a first -line treatment in advanced colorectal carcinoma and the toxicreaction was tolerable.The most likely part to occur colorectal cancer is rectum,which is different from the West countries.Easily transfer part of advanced colorectal cancer was liver,lung and bone successively.While, lung,bone metastasis was more common in rectal cancer.Colorectal cancer metastasis to the brain gradually in-creased.We found the right colon cancer has more poor prognosis than the left colon cancer,so left and right colon should be regarded as different organs.