论著摘要 |【PET】基于组学进行决策制定的结直肠肝转移精准手术的机会和挑战(双语版)

2017-08-25 13:35:35 admin 27

Precision surgery for colorectal liver metastases: Opportunities and challenges of omics-baseddecision making.

发表日期:2017.5.16   来源:Eur J Surg Oncol.

作者:Jones RP1Brudvik KW2Franklin JM3Poston GJ4.

作者介绍:

    1.North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK; School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. 

    2.Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.

    3.Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

    4.North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK.E

摘要

精准手术包括改善患者的选择,以确保证明在整体水平上受益的外科手术是每个患者的最佳治疗方法。对于具有结直肠肝转移(CRLM)的患者,现有的预后评分系统依赖于公认的组织病理学特征,例如病变的大小和数量。术前成像算法的进步意味着可以检测到越来越少体积的疾病,改善这些因素的评估。此外,新型成像方式意味着可以评估治疗期间潜在的肿瘤生物学和代谢行为。肿瘤的分子分析可以提供关键的预后信息,RAS / RAF突变在预后中的关键作用得到了很好的认可。这一水平分析的最佳组织来源受到争论,对于一些认可的预后因素,原发性和转移性病变之间具有良好的一致性,但是对于各种其他相关突变则显示出差异。除了原发性和转移性病变之间的突变异质性,肿瘤内的异质性和肿瘤生物学随时间的动态变化在评估肿瘤预后生物标志物方面是一个重大的挑战。循环肿瘤细胞提供一种潜在的纵向肿瘤分析方法,但受现有技术的限制。本综述文章总结了可切除结肠直肠肝转移酶患者预后的一些关键进展,并强调了这种方法的潜在局限性。

Precision surgery involves improving patient selection to ensure that surgical intervention that is proven to benefit on a population level is the optimal treatment for each individual patient. For patients with colorectal liver metastases (CRLM), existing prognostic scoring systems rely on well-recognised histopathological features such as size and number of lesions. Advances in preoperative imaging algorithms mean that increasingly low volume disease can be detected, improving assessment of these factors. In addition, novel imaging modalities mean that underlying tumour biology and metabolic behaviour during therapy can be assessed. Molecular analysis of tumours can provide crucial prognostic information, with the critical role of RAS/RAF mutations in prognosis well recognised. The optimal source of tissue for this level of analysis is debated, with good concordance between primary and metastatic lesions for some recognised prognostic factors but marked discrepancies for a variety of other relevant mutations. As well as mutational heterogeneity between primary and metastatic lesions, heterogeneity within tumours and dynamic changes in tumour biology over time present a significant challenge in assessing tumour for prognostic biomarkers. Circulating tumour cells offer one potential method of longitudinal tumour analysis, but are limited by current technologies. This review article summarises some of the key advances in prognostication for patients with resectable colorectal livermetastases, as well as highlighting the potential limitations of such an approach.

关键词

结直肠,肝,预后,RAFRAS,影像组学,切除

Colorectal; Liver; Prognostic; RAF; RAS; Radiomics; Resection


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