• 中國醫(yī)科大學(xué)附屬盛京醫(yī)院肝膽脾外科病房（遼寧沈陽 110004）;

目的總結(jié)老年結(jié)直腸癌肝轉(zhuǎn)移（CRCLM）治療的現(xiàn)狀，探討老年CRCLM治療的方法和原則。方法復(fù)習(xí)國內(nèi)、外近年來有關(guān)老年CRCLM治療的相關(guān)文獻(xiàn)并作綜述。結(jié)果結(jié)直腸癌是消化系統(tǒng)最常見的惡性腫瘤，而最常見的轉(zhuǎn)移部位是肝臟。近年來，老年結(jié)直腸癌發(fā)病率逐漸升高。雖然同年輕患者比較，老年CRCLM患者的身體狀態(tài)和生理機(jī)能較差，但只要選取合適的病例，同樣可以獲得與年輕患者相似的治療效果。目前，對(duì)于可切除的CRCLM患者，惟一可能治愈的手段仍然是外科手術(shù)治療; 而化療和分子靶向藥物治療的最新進(jìn)展，也讓更多的老年患者生存獲益。對(duì)于不可切除的CRCLM病灶尚可結(jié)合其他肝臟導(dǎo)向的局部治療方法，如局部化療、消融治療等。結(jié)論根據(jù)CRCLM的發(fā)病特點(diǎn)和老年患者的自身特點(diǎn)，采用多學(xué)科協(xié)作模式下的個(gè)體化治療模式，可進(jìn)一步提高老年CRCLM患者的綜合治療效果。

引用本文： 賈昌俊,戴朝六. 老年結(jié)直腸癌肝轉(zhuǎn)移的治療. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(5): 485-493. doi: 復(fù)制

1. Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010 [J]. CA Cancer J Clin, 2010, 60(5): 277300.
2. 張思維, 雷正龍, 李光琳, 等. 中國腫瘤登記地區(qū)2006年腫瘤發(fā)病和死亡資料分析 [J]. 中國腫瘤, 2010, 19(6): 356365.
3. 中華醫(yī)學(xué)會(huì)外科學(xué)分會(huì)胃腸外科學(xué)組、結(jié)直腸肛門外科學(xué)組, 中國抗癌協(xié)會(huì)大腸癌專業(yè)委員會(huì). 結(jié)直腸癌肝轉(zhuǎn)移診斷和治療指南（V 2010） [J]. 中華胃腸外科雜志, 2010, 13(6): 457470.
4. NCCN Clinical Practice Guidelines in Oncology (NCCN GuidelinesTM). Colon Cancer. Version 3.2011. http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf.
5. Foster JH. Treatment of metastatic disease of the liver: a skeptic’s view [J]. Semin Liver Dis, 1984, 4(2): 170179.
6. Wagner JS, Adson MA, Van Heerden JA, et al. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment [J]. Ann Surg, 1984, 199(5): 502508.
7. Morris EJ, Forman D, Thomas JD, et al. Surgical management and outcomes of colorectal cancer liver metastases [J]. Br J Surg, 2010, 97(7): 11101118.
8. Ito K, Govindarajan A, Ito H, et al. Surgical treatment of hepatic colorectal metastasis: evolving role in the setting of improving systemic therapies and ablative treatments in the 21st century [J]. Cancer J, 2010, 16(2): 103110.
9. Tsim NC, Frampton AE, Habib NA, et al. Surgical treatment for liver cancer [J]. World J Gastroenterol, 2010, 16(8): 927933.
10. Coleman MP, Forman D, Bryant H, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 19952007: an analysis of populationbased cancer registry data [J]. Lancet, 2011, 377(9760): 127138.
11. 中華人民共和國國家統(tǒng)計(jì)局. 2010年第六次全國人口普查主要數(shù)據(jù)公報(bào)（第1號(hào)）. http://www.stats.gov.cn/tjfx/jdfx/t20110428_402722253.html.
12. 杜鵬, 翟振武, 陳衛(wèi). 中國人口老齡化百年發(fā)展趨勢(shì) [J]. 人口研究, 2005, 29(6): 9093.
13. Sawhney R, Sehl M, Naeim A. Physiologic aspects of aging: impact on cancer management and decision making, part Ⅰ [J]. Cancer J, 2005, 11(6): 449460.
14. NCCN Clinical Practice Guidelines in Oncology (NCCN GuidelinesTM). Senior Adult Oncology. Version 2.2011. http://www.nccn.org/professionals/physician_gls/pdf/senior.pdf.
15. Pallis AG, Papamichael D, Audisio R, et al. EORTC Elderly Task Force experts’ opinion for the treatment of colon cancer in older patients [J]. Cancer Treat Rev, 2010, 36(1): 8390.
16. Brand MI, Saclarides TJ, Dobson HD, et al. Liver resection for colorectal cancer: liver metastases in the aged [J]. Ann Surg, 2000, 66(4): 412415， discussion 415416.
17. Zacharias T, Jaeck D, Oussoultzoglou E, et al. First and repeat resection of colorectal liver metastases in elderly patients [J]. Ann Surg, 2004, 240(5): 858865.
18. Nagano Y, Nojiri K, Matsuo K, et al. The impact of advanced age on hepatic resection of colorectal liver metastases [J]. J Am Coll surg, 2005, 201(4): 511516.
19. Menon KV, AlMukhtar A, Aldouri A, et al. Outcomes after major hepatectomy in elderly patients [J]. J Am Coll Surg, 2006, 203(5): 677683.
20. Figueras J, Ramos E, LopezBen S, et al. Surgical treatment of liver metastases from colorectal carcinoma in elderly patients. When is it worthwhile? [J]. Clin Transl Oncol, 2007, 9(6): 392400.
21. Mazzoni G, Tocchi A, Miccini M, et al. Surgical treatment of liver metastases from colorectal cancer in elderly patients [J]. Int J Colorectal Dis, 2007, 22(1): 7783.
22. Wang X, Hershman DL, Abrams JA, et al. Predictors of survival after hepatic resection among patients with colorectal liver metastasis [J]. Br J Cancer, 2007, 97(12): 16061612.
23. de LiguoriCarino N, van Leeuwen BL, Ghaneh P, et al. Liver resection for colorectal liver metastases in older patients [J]. Crit Rev Oncol Hematol, 2008, 67(3): 273278.
24. Mann CD, Neal CP, Pattenden CJ, et al. Major resection of hepatic colorectal liver metastases in elderly patients - an aggressive approach is justified [J]. Eur J Surg Oncol, 2008, 34(4): 428432.
25. Bockhorn M, Sotiropoulos GC, Sgourakis G, et al. Major liver resections in the elderly-is an aggressive approach justified? [J]. Int J Colorectal Dis, 2009, 24(1): 8386.
26. Nojiri K, Nagano Y, Tanaka K, et al. Validity of hepatic resection of colorectal liver metastases in the elderly (75 years and older) [J]. Anticancer Res, 2009, 29(2): 583588.
27. Tamandl D, Gruenberger B, Herberger B, et al. Surgery after neoadjuvant chemotherapy for colorectal liver metastases is safe and feasible in elderly patients [J]. J Surg Oncol, 2009, 100(5): 364371.
28. Robertson DJ, Stukel TA, Gottlieb DJ, et al. Survival after hepatic resection of colorectal cancer metastases: a national experience [J]. Cancer, 2009, 15(4): 752759.
29. Rees M, Tekkis PP, Welsh FK, et al. Evaluation of longterm survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients [J]. Ann Surg, 2008, 247(1): 125135.
30. Reddy SK, Barbas AS, Turley RS, et al. Major liver resection in elderly patients: a multiinstitutional analysis [J]. J Am Coll Surg, 2011, 212(5): 787795.
31. 蔡三軍. 結(jié)直腸癌肝轉(zhuǎn)移的治療現(xiàn)狀 [J]. 中華胃腸外科雜志, 2009, 12(4): 430431.
32. Thelen A, Jonas S, Benckert C, et al. Simultaneous versus staged liver resection onf synchronous liver metastasis from colorectal cancer [J]. Int J Colorectal Dis, 2007, 22(10): 12691276.
33. 涂玉亮, 焦華波, 譚向東, 等. 70歲以上老年患者結(jié)直腸癌肝轉(zhuǎn)移同步手術(shù)切除的臨床分析 [J]. 中國急救復(fù)蘇與災(zāi)害醫(yī)學(xué)雜志, 2010, 5(8): 734736, 744.
34. Brouquet A, Abdalla EK, Kopetz S, et al. High survival rate after twostage resection of advanced colorectal liver metastases: responsebased selection and complete resection define outcome [J]. J Clin Oncol, 2011, 29(8): 10831090.
35. Wicherts DA, Miller R, de Haas RJ, et al. Longterm results of twostage hepatectomy for irresectable colorectal cancer liver metastases [J]. Ann Surg, 2008, 248(6): 9941005.
36. Karoui M, Viqano L, Goyer P, et al. Combined firststage hepatectomy and colorectal resection in a twostage hepatectomy strategy for bilobar synchronous liver metastases [J]. Br J Surg, 2010， 97(9): 13541362.
37. Mohammad WM, Balaa FK. Surgical management of colorectal liver metastases [J]. Clin Colon Rectal Surg, 2009, 22(4): 225232.
38. de Jong MC, Mayo SC, Pulitano C, et al. Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastases: results from an international multiinstitutional analysis [J]. J Gastrointest Surg, 2009, 13(12): 21412151.
39. Sa Cunha A, Laurent C, Rault A, et al. A second liver resection due to recurrent colorectal liver metastases [J]. Arch Surg, 2007, 142(12): 11441149.
40. de Liquori Carino N, van Leeuwen BL, Ghaneh P, et al. Liver resection for colorectal liver metastases in older patients [J]. Crit Rev Oncol Hematol, 2008, 67(3): 273278.
41. Adam R, Bhanqui P, Poston G, et al. Is perioperative chemotherapy useful for solitary, metachronous, colorectal liver metastases? [J]. Ann Surg, 2010, 252(5): 774787.
42. Nordlinger B, Van Cutsem E, Rouqier P, et al. Does chemotherapy prior to liver resection increase the potential for cure in patients with metastatic colorectal cancer? A report from the European Colorectal Metastases Treatment Group [J]. Eur J Cancer, 2007, 43(14): 20372045.
43. Poultsides GA, Servais EL, Saltz LB, et al. Outcome of primary tumor in patients with synchronous stage Ⅳ colorectal cancer receiving combination chemotherapy without surgery as initial treatment [J]. J Clin Oncol, 2009, 27(20): 33793384.
44. Costi R, Di Mauro D, Giordano P, et al. Impact of palliative chemotherapy and surgery on management of stage Ⅳ incurable colorectal cancer [J]. Ann Surg Oncol, 2010, 17(2): 432440.
45. Costi R, Di Mauro D, Veronesi L, et al. Elective palliative resection of incurable stage Ⅳ colorectal cancer: who really benefits from it? [J]. Surg Today, 2011, 41(2): 222229.
46. Nquyen HL, Hwang J. Treatment of metastatic colorectal cancer in the elderly [J]. Curr Treat Options Oncol, 2009, 10(56): 287295.
47. Power DG, Lichtman SM. Chemotherapy for the elderly patient with colorectal cancer [J]. Cancer J, 2010, 16(3): 241252.
48. Berretta M, Cappellani A, Fiorica F, et al. FOLFOX4 in the treatment of metastatic colorectal cancer in elderly patients: a prospective study [J]. Arch Gerontol Geriatr, 2011, 52(1): 8993.
49. 丁麗, 武曉楠, 程剛. 奧沙利鉑聯(lián)合氟尿嘧啶和亞葉酸鈣方案治療70歲及以上轉(zhuǎn)移性結(jié)直腸癌的療效和安全性 [J]. 中華老年醫(yī)學(xué)雜志, 2010, 30(2): 129132.
50. Suqimoto S, Katano K, Kanazawa A, et al. Multicenter safety study of mFOLFOX6 for unresectable advanced/recurrent colorectal cancer in elderly patients [J]. J Exp Clin Cancer Res, 2009, 28: 109.
51. Sastre J, Aranda E, Massutí B, et al. Elderly patients with advanced colorectal cancer derive similar benefit without excessive toxicity after firstline chemotherapy with oxaliplatinbased combinations: Comparative outcomes from the 03TTD01 phase Ⅲ study [J]. Crit Rev in Oncol Hematol, 2009, 70(2): 134144.
52. Folprecht G, Seymour MT, Saltz L, et al. Irinotecan/fluorouracil combination in firstline therapy of older and younger patients with metastatic colorectal cancer: combined analysis of 2 691 patients in randomized controlled trials [J]. J Clin Oncol, 2008, 26(9): 14431451.
53. Jackson NA, Barrueco J, SoufiMahjoubi R, et al. Comparing safety and efficacy of firstline irinotecan/fluoropyrimidine combinations in elderly versus nonelderly patients with metastatic colorectal cancer: findings from the bolus, infusional, or capecitabine with camptostarcelecoxib study [J]. Cancer, 2009, 115(12): 26172629.
54. Vamvakas L, Athanasiadis A, Karampeazis A, et al. Clinical outcome of elderly patients with metastatic colorectal cancer treated with FOLFOXIRI versus FOLFIRI: Subgroup analysis of a randomized phase Ⅲ trial from the Hellenic Oncology Research Group (HORG) [J]. Crit Rev Oncol Hematol, 2010, 76(1): 6170.
55. Feliu J, Safont MJ, Salud A, et al. Capecitabine and bevacizumab as firstline treatment in elderly patients with metastatic colorectal cancer [J]. Br J Cancer, 2010, 102(10): 14681473.
56. Vrdoljak E, Omrˇcen T, Boban M, et al. Phase Ⅱ study of bevacizumab in combination with capecitabine as firstline treatment in elderly patients with metastatic colorectal cancer [J]. Anticancer Drugs, 2011, 22(2): 191197.
57. Hess GP, Wang PF, Quach D, et al. Systemic therapy for metastatic colorectal cancer: patterns of chemotherapy and biologic therapy use in US medical oncology practice [J]. J Oncol Pract, 2010, 6(6): 301307.
58. Cassidy J, Saltz LB, Giantonio BJ, et al. Effect of bevacizumab in older patients with metastatic colorectal cancer: pooled analysis of four randomized studies [J]. J Cancer Res Clin Oncol, 2010, 136(5): 737743.
59. Kozloff MF, Berlin J, Flynn PJ, et al. Clinical outcomes in elderly patients with metastatic colorectal cancer receiving bevacizumab and chemotherapy: results from the BRiTE observational cohort study [J]. Oncology, 2010, 78(56): 329339.
60. Van Cutsem E, Rivera F, Berry S, et al. PD0005. Safety and efficacy of bevacizumab and chemotherapy in elderly patients with metastatic colorectal cancer (MCRC): results from the BEAT observational cohort study [J]. Ann Oncol, 2009, 20(Supplement 7): vi18.
61. Bouchahda M, Macarulla T, Spano JP, et al. Cetuximab efficacy and safety in a retrospective cohort of elderly patients with heavily pretreated metastatic colorectal cancer [J]. Crit Rev Oncol Hematol, 2008, 67(3): 255262.
62. Fornaro L, Baldi GG, Masi G, et al. Cetuximab plus irinotecan after irinotecan failure in elderly metastatic colorectal cancer patients: Clinical outcome according to KRAS and BRAF mutational status [J]. Crit Rev Oncol Hematol, 2010, doi: 10.1016/j.critrevonc. 2010. 06. 003.
63. Sastre J, Aranda E, Grávalos C, et al. Firstline singleagent cetuximab in elderly patients with metastatic colorectal cancer. A phase Ⅱ clinical and molecular study of the Spanish group for digestive tumor therapy (TTD) [J]. Crit Rev Oncol Hematol, 2011, 77(1): 7884.
64. Amado RG, Wolf M, Peeters M, et al. Wildtype KRAS is required for panitumumab efficacy in patients with metastatic colorectal cancer [J]. J Clin Oncol, 2008, 26(10): 16261634.
65. Peeters M, Price TJ, Cervantes A, et al. Randomized phase Ⅲ study of panitumumab with fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as secondline treatment in patients with metastatic colorectal cancer [J]. J Clin Oncol, 2010, 28(31): 47064713.
66. Douillard JY, Siena S, Cassidy J, et al. Randomized, phase Ⅲ trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as firstline treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study [J]. J Clin Oncol, 2010, 28(31): 46974705.
67. Mocellin S, Pasquali S, Nitti D. FluoropyrimidineHAI (hepatic arterial infusion) versus systemic chemotherapy (SCT) for unresectable liver metastases from colorectal cancer [J]. Cochrane Database Syst Rev, 2009, (3): CD007823.
68. Faynsod M, Wagman LD, Longmate J, et al. Improved hepatic toxicity profile of portal vein adjuvant hepatic infusional chemotherapy [J]. J Clin Oncol, 2005, 23(22): 48764880.
69. Hong K, McBride JD, Gerorgiades CS, et al. Salvage therapy for liver dominant colorectal metastatic adenocarcinoma: comparison between transcatheter arterial chemoembolization versus yttrium90 radioembolization [J]. J Vasc Interv Radiol, 2009, 20(3): 360367.
70. 賈昌俊, 薛今琦, 戴朝六. 肝臟腫瘤原位組織消融治療進(jìn)展 [J]. 中國實(shí)用外科雜志, 2008, 28(8): 669671.
71. Abdalla EK. Commentary: Radiofrequency ablation for colorectal liver metastases: do not blame the biology when it is the technology [J]. Am J Surg, 2009, 197(6): 737739.
72. Tsoulfas G, Pramateftakis MG, Kanellos I. Surgical treatment of hepatic metastases from colorectal cancer [J]. World J Gastrointest Oncol, 2011, 3(1): 19.
  1. 1. Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010 [J]. CA Cancer J Clin, 2010, 60(5): 277300.
  2. 2. 張思維, 雷正龍, 李光琳, 等. 中國腫瘤登記地區(qū)2006年腫瘤發(fā)病和死亡資料分析 [J]. 中國腫瘤, 2010, 19(6): 356365.
  3. 3. 中華醫(yī)學(xué)會(huì)外科學(xué)分會(huì)胃腸外科學(xué)組、結(jié)直腸肛門外科學(xué)組, 中國抗癌協(xié)會(huì)大腸癌專業(yè)委員會(huì). 結(jié)直腸癌肝轉(zhuǎn)移診斷和治療指南（V 2010） [J]. 中華胃腸外科雜志, 2010, 13(6): 457470.
  4. 4. NCCN Clinical Practice Guidelines in Oncology (NCCN GuidelinesTM). Colon Cancer. Version 3.2011. http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf.
  5. 5. Foster JH. Treatment of metastatic disease of the liver: a skeptic’s view [J]. Semin Liver Dis, 1984, 4(2): 170179.
  6. 6. Wagner JS, Adson MA, Van Heerden JA, et al. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment [J]. Ann Surg, 1984, 199(5): 502508.
  7. 7. Morris EJ, Forman D, Thomas JD, et al. Surgical management and outcomes of colorectal cancer liver metastases [J]. Br J Surg, 2010, 97(7): 11101118.
  8. 8. Ito K, Govindarajan A, Ito H, et al. Surgical treatment of hepatic colorectal metastasis: evolving role in the setting of improving systemic therapies and ablative treatments in the 21st century [J]. Cancer J, 2010, 16(2): 103110.
  9. 9. Tsim NC, Frampton AE, Habib NA, et al. Surgical treatment for liver cancer [J]. World J Gastroenterol, 2010, 16(8): 927933.
  10. 10. Coleman MP, Forman D, Bryant H, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 19952007: an analysis of populationbased cancer registry data [J]. Lancet, 2011, 377(9760): 127138.
  11. 11. 中華人民共和國國家統(tǒng)計(jì)局. 2010年第六次全國人口普查主要數(shù)據(jù)公報(bào)（第1號(hào)）. http://www.stats.gov.cn/tjfx/jdfx/t20110428_402722253.html.
  12. 12. 杜鵬, 翟振武, 陳衛(wèi). 中國人口老齡化百年發(fā)展趨勢(shì) [J]. 人口研究, 2005, 29(6): 9093.
  13. 13. Sawhney R, Sehl M, Naeim A. Physiologic aspects of aging: impact on cancer management and decision making, part Ⅰ [J]. Cancer J, 2005, 11(6): 449460.
  14. 14. NCCN Clinical Practice Guidelines in Oncology (NCCN GuidelinesTM). Senior Adult Oncology. Version 2.2011. http://www.nccn.org/professionals/physician_gls/pdf/senior.pdf.
  15. 15. Pallis AG, Papamichael D, Audisio R, et al. EORTC Elderly Task Force experts’ opinion for the treatment of colon cancer in older patients [J]. Cancer Treat Rev, 2010, 36(1): 8390.
  16. 16. Brand MI, Saclarides TJ, Dobson HD, et al. Liver resection for colorectal cancer: liver metastases in the aged [J]. Ann Surg, 2000, 66(4): 412415， discussion 415416.
  17. 17. Zacharias T, Jaeck D, Oussoultzoglou E, et al. First and repeat resection of colorectal liver metastases in elderly patients [J]. Ann Surg, 2004, 240(5): 858865.
  18. 18. Nagano Y, Nojiri K, Matsuo K, et al. The impact of advanced age on hepatic resection of colorectal liver metastases [J]. J Am Coll surg, 2005, 201(4): 511516.
  19. 19. Menon KV, AlMukhtar A, Aldouri A, et al. Outcomes after major hepatectomy in elderly patients [J]. J Am Coll Surg, 2006, 203(5): 677683.
  20. 20. Figueras J, Ramos E, LopezBen S, et al. Surgical treatment of liver metastases from colorectal carcinoma in elderly patients. When is it worthwhile? [J]. Clin Transl Oncol, 2007, 9(6): 392400.
  21. 21. Mazzoni G, Tocchi A, Miccini M, et al. Surgical treatment of liver metastases from colorectal cancer in elderly patients [J]. Int J Colorectal Dis, 2007, 22(1): 7783.
  22. 22. Wang X, Hershman DL, Abrams JA, et al. Predictors of survival after hepatic resection among patients with colorectal liver metastasis [J]. Br J Cancer, 2007, 97(12): 16061612.
  23. 23. de LiguoriCarino N, van Leeuwen BL, Ghaneh P, et al. Liver resection for colorectal liver metastases in older patients [J]. Crit Rev Oncol Hematol, 2008, 67(3): 273278.
  24. 24. Mann CD, Neal CP, Pattenden CJ, et al. Major resection of hepatic colorectal liver metastases in elderly patients - an aggressive approach is justified [J]. Eur J Surg Oncol, 2008, 34(4): 428432.
  25. 25. Bockhorn M, Sotiropoulos GC, Sgourakis G, et al. Major liver resections in the elderly-is an aggressive approach justified? [J]. Int J Colorectal Dis, 2009, 24(1): 8386.
  26. 26. Nojiri K, Nagano Y, Tanaka K, et al. Validity of hepatic resection of colorectal liver metastases in the elderly (75 years and older) [J]. Anticancer Res, 2009, 29(2): 583588.
  27. 27. Tamandl D, Gruenberger B, Herberger B, et al. Surgery after neoadjuvant chemotherapy for colorectal liver metastases is safe and feasible in elderly patients [J]. J Surg Oncol, 2009, 100(5): 364371.
  28. 28. Robertson DJ, Stukel TA, Gottlieb DJ, et al. Survival after hepatic resection of colorectal cancer metastases: a national experience [J]. Cancer, 2009, 15(4): 752759.
  29. 29. Rees M, Tekkis PP, Welsh FK, et al. Evaluation of longterm survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients [J]. Ann Surg, 2008, 247(1): 125135.
  30. 30. Reddy SK, Barbas AS, Turley RS, et al. Major liver resection in elderly patients: a multiinstitutional analysis [J]. J Am Coll Surg, 2011, 212(5): 787795.
  31. 31. 蔡三軍. 結(jié)直腸癌肝轉(zhuǎn)移的治療現(xiàn)狀 [J]. 中華胃腸外科雜志, 2009, 12(4): 430431.
  32. 32. Thelen A, Jonas S, Benckert C, et al. Simultaneous versus staged liver resection onf synchronous liver metastasis from colorectal cancer [J]. Int J Colorectal Dis, 2007, 22(10): 12691276.
  33. 33. 涂玉亮, 焦華波, 譚向東, 等. 70歲以上老年患者結(jié)直腸癌肝轉(zhuǎn)移同步手術(shù)切除的臨床分析 [J]. 中國急救復(fù)蘇與災(zāi)害醫(yī)學(xué)雜志, 2010, 5(8): 734736, 744.
  34. 34. Brouquet A, Abdalla EK, Kopetz S, et al. High survival rate after twostage resection of advanced colorectal liver metastases: responsebased selection and complete resection define outcome [J]. J Clin Oncol, 2011, 29(8): 10831090.
  35. 35. Wicherts DA, Miller R, de Haas RJ, et al. Longterm results of twostage hepatectomy for irresectable colorectal cancer liver metastases [J]. Ann Surg, 2008, 248(6): 9941005.
  36. 36. Karoui M, Viqano L, Goyer P, et al. Combined firststage hepatectomy and colorectal resection in a twostage hepatectomy strategy for bilobar synchronous liver metastases [J]. Br J Surg, 2010， 97(9): 13541362.
  37. 37. Mohammad WM, Balaa FK. Surgical management of colorectal liver metastases [J]. Clin Colon Rectal Surg, 2009, 22(4): 225232.
  38. 38. de Jong MC, Mayo SC, Pulitano C, et al. Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastases: results from an international multiinstitutional analysis [J]. J Gastrointest Surg, 2009, 13(12): 21412151.
  39. 39. Sa Cunha A, Laurent C, Rault A, et al. A second liver resection due to recurrent colorectal liver metastases [J]. Arch Surg, 2007, 142(12): 11441149.
  40. 40. de Liquori Carino N, van Leeuwen BL, Ghaneh P, et al. Liver resection for colorectal liver metastases in older patients [J]. Crit Rev Oncol Hematol, 2008, 67(3): 273278.
  41. 41. Adam R, Bhanqui P, Poston G, et al. Is perioperative chemotherapy useful for solitary, metachronous, colorectal liver metastases? [J]. Ann Surg, 2010, 252(5): 774787.
  42. 42. Nordlinger B, Van Cutsem E, Rouqier P, et al. Does chemotherapy prior to liver resection increase the potential for cure in patients with metastatic colorectal cancer? A report from the European Colorectal Metastases Treatment Group [J]. Eur J Cancer, 2007, 43(14): 20372045.
  43. 43. Poultsides GA, Servais EL, Saltz LB, et al. Outcome of primary tumor in patients with synchronous stage Ⅳ colorectal cancer receiving combination chemotherapy without surgery as initial treatment [J]. J Clin Oncol, 2009, 27(20): 33793384.
  44. 44. Costi R, Di Mauro D, Giordano P, et al. Impact of palliative chemotherapy and surgery on management of stage Ⅳ incurable colorectal cancer [J]. Ann Surg Oncol, 2010, 17(2): 432440.
  45. 45. Costi R, Di Mauro D, Veronesi L, et al. Elective palliative resection of incurable stage Ⅳ colorectal cancer: who really benefits from it? [J]. Surg Today, 2011, 41(2): 222229.
  46. 46. Nquyen HL, Hwang J. Treatment of metastatic colorectal cancer in the elderly [J]. Curr Treat Options Oncol, 2009, 10(56): 287295.
  47. 47. Power DG, Lichtman SM. Chemotherapy for the elderly patient with colorectal cancer [J]. Cancer J, 2010, 16(3): 241252.
  48. 48. Berretta M, Cappellani A, Fiorica F, et al. FOLFOX4 in the treatment of metastatic colorectal cancer in elderly patients: a prospective study [J]. Arch Gerontol Geriatr, 2011, 52(1): 8993.
  49. 49. 丁麗, 武曉楠, 程剛. 奧沙利鉑聯(lián)合氟尿嘧啶和亞葉酸鈣方案治療70歲及以上轉(zhuǎn)移性結(jié)直腸癌的療效和安全性 [J]. 中華老年醫(yī)學(xué)雜志, 2010, 30(2): 129132.
  50. 50. Suqimoto S, Katano K, Kanazawa A, et al. Multicenter safety study of mFOLFOX6 for unresectable advanced/recurrent colorectal cancer in elderly patients [J]. J Exp Clin Cancer Res, 2009, 28: 109.
  51. 51. Sastre J, Aranda E, Massutí B, et al. Elderly patients with advanced colorectal cancer derive similar benefit without excessive toxicity after firstline chemotherapy with oxaliplatinbased combinations: Comparative outcomes from the 03TTD01 phase Ⅲ study [J]. Crit Rev in Oncol Hematol, 2009, 70(2): 134144.
  52. 52. Folprecht G, Seymour MT, Saltz L, et al. Irinotecan/fluorouracil combination in firstline therapy of older and younger patients with metastatic colorectal cancer: combined analysis of 2 691 patients in randomized controlled trials [J]. J Clin Oncol, 2008, 26(9): 14431451.
  53. 53. Jackson NA, Barrueco J, SoufiMahjoubi R, et al. Comparing safety and efficacy of firstline irinotecan/fluoropyrimidine combinations in elderly versus nonelderly patients with metastatic colorectal cancer: findings from the bolus, infusional, or capecitabine with camptostarcelecoxib study [J]. Cancer, 2009, 115(12): 26172629.
  54. 54. Vamvakas L, Athanasiadis A, Karampeazis A, et al. Clinical outcome of elderly patients with metastatic colorectal cancer treated with FOLFOXIRI versus FOLFIRI: Subgroup analysis of a randomized phase Ⅲ trial from the Hellenic Oncology Research Group (HORG) [J]. Crit Rev Oncol Hematol, 2010, 76(1): 6170.
  55. 55. Feliu J, Safont MJ, Salud A, et al. Capecitabine and bevacizumab as firstline treatment in elderly patients with metastatic colorectal cancer [J]. Br J Cancer, 2010, 102(10): 14681473.
  56. 56. Vrdoljak E, Omrˇcen T, Boban M, et al. Phase Ⅱ study of bevacizumab in combination with capecitabine as firstline treatment in elderly patients with metastatic colorectal cancer [J]. Anticancer Drugs, 2011, 22(2): 191197.
  57. 57. Hess GP, Wang PF, Quach D, et al. Systemic therapy for metastatic colorectal cancer: patterns of chemotherapy and biologic therapy use in US medical oncology practice [J]. J Oncol Pract, 2010, 6(6): 301307.
  58. 58. Cassidy J, Saltz LB, Giantonio BJ, et al. Effect of bevacizumab in older patients with metastatic colorectal cancer: pooled analysis of four randomized studies [J]. J Cancer Res Clin Oncol, 2010, 136(5): 737743.
  59. 59. Kozloff MF, Berlin J, Flynn PJ, et al. Clinical outcomes in elderly patients with metastatic colorectal cancer receiving bevacizumab and chemotherapy: results from the BRiTE observational cohort study [J]. Oncology, 2010, 78(56): 329339.
  60. 60. Van Cutsem E, Rivera F, Berry S, et al. PD0005. Safety and efficacy of bevacizumab and chemotherapy in elderly patients with metastatic colorectal cancer (MCRC): results from the BEAT observational cohort study [J]. Ann Oncol, 2009, 20(Supplement 7): vi18.
  61. 61. Bouchahda M, Macarulla T, Spano JP, et al. Cetuximab efficacy and safety in a retrospective cohort of elderly patients with heavily pretreated metastatic colorectal cancer [J]. Crit Rev Oncol Hematol, 2008, 67(3): 255262.
  62. 62. Fornaro L, Baldi GG, Masi G, et al. Cetuximab plus irinotecan after irinotecan failure in elderly metastatic colorectal cancer patients: Clinical outcome according to KRAS and BRAF mutational status [J]. Crit Rev Oncol Hematol, 2010, doi: 10.1016/j.critrevonc. 2010. 06. 003.
  63. 63. Sastre J, Aranda E, Grávalos C, et al. Firstline singleagent cetuximab in elderly patients with metastatic colorectal cancer. A phase Ⅱ clinical and molecular study of the Spanish group for digestive tumor therapy (TTD) [J]. Crit Rev Oncol Hematol, 2011, 77(1): 7884.
  64. 64. Amado RG, Wolf M, Peeters M, et al. Wildtype KRAS is required for panitumumab efficacy in patients with metastatic colorectal cancer [J]. J Clin Oncol, 2008, 26(10): 16261634.
  65. 65. Peeters M, Price TJ, Cervantes A, et al. Randomized phase Ⅲ study of panitumumab with fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as secondline treatment in patients with metastatic colorectal cancer [J]. J Clin Oncol, 2010, 28(31): 47064713.
  66. 66. Douillard JY, Siena S, Cassidy J, et al. Randomized, phase Ⅲ trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as firstline treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study [J]. J Clin Oncol, 2010, 28(31): 46974705.
  67. 67. Mocellin S, Pasquali S, Nitti D. FluoropyrimidineHAI (hepatic arterial infusion) versus systemic chemotherapy (SCT) for unresectable liver metastases from colorectal cancer [J]. Cochrane Database Syst Rev, 2009, (3): CD007823.
  68. 68. Faynsod M, Wagman LD, Longmate J, et al. Improved hepatic toxicity profile of portal vein adjuvant hepatic infusional chemotherapy [J]. J Clin Oncol, 2005, 23(22): 48764880.
  69. 69. Hong K, McBride JD, Gerorgiades CS, et al. Salvage therapy for liver dominant colorectal metastatic adenocarcinoma: comparison between transcatheter arterial chemoembolization versus yttrium90 radioembolization [J]. J Vasc Interv Radiol, 2009, 20(3): 360367.
  70. 70. 賈昌俊, 薛今琦, 戴朝六. 肝臟腫瘤原位組織消融治療進(jìn)展 [J]. 中國實(shí)用外科雜志, 2008, 28(8): 669671.
  71. 71. Abdalla EK. Commentary: Radiofrequency ablation for colorectal liver metastases: do not blame the biology when it is the technology [J]. Am J Surg, 2009, 197(6): 737739.
  72. 72. Tsoulfas G, Pramateftakis MG, Kanellos I. Surgical treatment of hepatic metastases from colorectal cancer [J]. World J Gastrointest Oncol, 2011, 3(1): 19.