摘要
局部进展期结直肠癌患者存在预后差和复发率高的特点,其腹膜转移发生率高达20%~30%。尽管根治性切除和化疗是主要治疗手段,但在预防腹膜转移方面仍存在挑战。新辅助治疗和免疫治疗为其研究热点,而腹腔热灌注化疗(HIPEC)作为预防腹膜转移的新手段之一,其价值和安全性仍存在争议。HIPEC通过高热效应和高浓度化疗药物可直接作用于腹腔内游离肿瘤细胞,但其预防性使用的效果和风险仍需进一步探讨。早期干预和识别高危因素对提高疗效至关重要,循环肿瘤DNA和腹腔游离细胞DNA等检测为早期筛查提供了新途径。预防性HIPEC的价值在不同研究中结果不一,而其并发症和风险也不容忽视。化疗药物的选择、剂量和治疗方案的个体化是影响疗效的关键因素。其他预防策略如腹腔加压雾化化疗和新辅助化疗也在探索中。总之,预防性HIPEC在控制腹膜转移方面显示出一定的潜能,但其应用需个体化评估和优化。
Locally advanced colorectal cancer patients are characterized by poor prognosis and high recurrence rates,with peritoneal metastasis rates as high as 20%-30%.Despite curative resection and chemotherapy being the main treatment methods,challenges remain in preventing peritoneal metastasis.Neoadjuvant therapy and immunotherapy are hot topics of research,and hyperthermic intraperitoneal chemotherapy(HIPEC)is one of the new approaches for preventing peritoneal metastasis,yet its value and safety are still controversial.HIPEC can directly target free tumor cells in the abdominal cavity through hyperthermic effects and high concentrations of chemotherapeutic drugs,but its prophylactic use requires further exploration regarding effectiveness and risks.Early intervention and identification of high-risk factors are crucial for improving therapeutic outcomes,and tests such as circulating tumor DNA and free peritoneal cell DNA provide new avenues for early screening.The value of prophylactic HIPEC varies across different studies,and its complications and risks should not be overlooked.The selection of chemotherapy drugs,dosage,and personalized treatment plans are key factors affecting therapeutic efficacy.Other prevention strategies,such as pressurized intraperitoneal aerosol chemotherapy and neoadjuvant chemotherapy,are also being explored.In summary,prophylactic HIPEC shows some potential in controlling peritoneal metastasis,but its application requires individualized assessment and optimization.
作者
蓝冰
秦秀森
王辉
Lan Bing;Qin Xiusen;Wang Hui(Department of General Surgery(Colorectal Surgery),the Sixth Affiliated Hospital,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases,the Sixth Affiliated Hospital,Sun Yat-sen University,Biomedical Innovation Center,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangdong Province Biomedical Material Conversion and Evaluation Engineering Technology Center,Guangzhou 510655,China)
出处
《中华胃肠外科杂志》
北大核心
2025年第7期804-809,共6页
Chinese Journal of Gastrointestinal Surgery
基金
国家自然科学基金项目(22371312)
中山大学附属第六医院“1010”计划资助[1010CG(2022)-08]。
关键词
结直肠肿瘤
局部进展期
腹腔热灌注化疗
预防性治疗
腹膜转移
Colorectal neoplasms,locally advanced
Hyperthermic intraperitoneal chemotherapy(HIPEC)
Prophylactic treatment
Peritoneal metastasis
