摘要
2010年有关结肠癌、直肠癌诊治理念更新众多,第7版AJCC(美国肿瘤联合会)分期标准成为本年度肿瘤学界的重大事件,新的分期标准旨在更为客观地为不同分期的结、直肠肿瘤提供更为精准的预后评价。其中T4、N1、N2、M1的界定更加细化是重点。2010年NCCN(美国国立综合癌症网络)结肠癌指南变更重点包括TNM分期诊断标准更新为AJCC第7版;外科手术部分无变更;强调辅助治疗病例应作错配修复缺失检测(deficient mismatch repair,dMMR);转移性结肠癌新增BRAF基因检查;帕尼单抗作为全人源化的靶向药物,同样要选择检测KRAS基因,野生型病人才是药物使用的适应证;重申贝伐单抗、西妥昔单抗、伊立替康不适于辅助治疗(仅限于解救)以及不推荐PET-CT用于病情进展监测。直肠癌指南变更外科部分仅有经肛门手术限于T1期。多年以来AJCC分期标准与NCCN临床实践指南各自从不同的角度为临床提供了借鉴,由于种族不同、地域有别以及肿瘤的异质性,更新后的标准一定需要接受临床实践的检验,才能达到进一步完善。
There are many updates about the diagnosis and treatment of colorectal cancer in 2010. Of these the most important event is the publication of the 7th Edition of the AJCC staging Manual. The new standard of staging can provide more precise information about the prognosis of colorectal cancer, and the emphases are the definitions of T4, N1, N2 and M1. The updates of NCCN clinical practice guidelines in oncology of colon cancer include： the TNM staging was updated to reflect the 7th Edition of the AJCC Staging Manual; there were no changes in the part of surgery; mismatch repair （MMR） testing was recommended in stage Ⅱ patients who considers 5-Fu as adjuvant chemotherapy; the recommendation of BRAF mutation testing is added in metastatic colon cancer. Panitumumab which is a fully human monoclonal antibody should also be used on the basis of KRAS mutation testing; Bevacizumab, cetuximab and irinotecan should not be used for adjuvant chemotherapy and PET-CT should not be used to monitor progress of therapy. The update of NCCN guidelines of rectal cancer in surgery part is the transanal excision is only recommended for T1, N0.For many years the AJCC Staging Manual and NCCN clinical practice guidelines in oncology offer sufficient information for clinic. But due to the difference of race and region and the heterogeneity of tumor, the new updates would go better through the clinical practice.
出处
《中国实用外科杂志》
CSCD
北大核心
2010年第9期763-768,共6页
Chinese Journal of Practical Surgery
关键词
结直肠癌
癌症分期
NCCN指南
colonrectal cancer
AJCC staging manual
NCCN clinical practive guidilines
