查看更多>>摘要：结直肠癌腹主动脉旁淋巴结转移相对罕见。文献显示，根治性腹主动脉旁淋巴结清扫可使部分患者获得类似Ⅲ期结直肠癌的预后。关于结直肠癌腹主动脉旁淋巴结转移的手术指征、清扫区域和处理原则，仍有很多问题尚存争议，制约了该技术的推广和疗效评价。随着腹腔镜结直肠手术技术的提升，使得腹主动脉旁淋巴结清扫这项曾因操作复杂、高风险而令很多外科医生望而却步的术式变得安全可行。但该领域尚存在诸多问题，为了证实这项操作的生存获益，亟待开展多中心临床研究，以获得更多的高级别循证医学证据。 Para-aortic lymph node metastasis from colorectal cancer is relatively rare. Recent studies have shown that curative para-aortic lymph node dissection can lead to similar prognoses as stage III colorectal cancer for selected patients. However, there are still many unresolved debates regarding the appropriate surgical indications, extent of lymph node dissection, and treatment principles for colorectal cancer patients with para-aortic lymph node metastasis. With the continuous improvement of laparoscopic colorectal surgery techniques, the previously complex and high-risk procedure of para-aortic lymph node dissection has now become a safe and feasible approach. However, there are still several challenges that need to be addressed in this field. It is imperative to conduct multicenter clinical studies to demonstrate the survival benefits of this surgical procedure into greater survival benefits. This will help generate more robust evidence in the field of evidence-based medicine.
查看更多>>摘要：影响食管癌患者生存的一个重要参数是淋巴结是否有转移，淋巴结转移主要由组织学类型和肿瘤浸润深度来决定。然而，受肿瘤的病理学特征、异质性和个体差异的影响，目前食管癌淋巴结的分期系统尚未统一，转移规律尚不完全明确，清扫的范围尚有争论；且食管癌淋巴结分期系统尚不完善，其可能导致对患者病情评估不准确，影响临床医生对患者治疗方式的选择，甚至影响临床试验的结论。因此，有必要对食管癌淋巴结分期进一步优化，以便更好地指导以手术为主的综合治疗决策和评估疗效及判断患者预后。 The status of lymph node metastasis is an important parameter affecting the survival of patients with esophageal carcinoma, which is primarily determined by histological type and the depth of invasion. However, affected by pathological features, heterogeneity and individual differences of tumors, the present staging system of lymph node in esophageal carcinoma has not been unified, the rule of lymph node metastasis remains unclear, and the extent of lymphadenectomy is still controversial. Current lymph node staging system for esophageal carcinoma may be not effective enough, which may lead to inaccurate assessment of the stage and affect the clinicians' choice of treatment modalities, or even affect the conclusions of clinical trials. Therefore, it is essential to optimize the current lymph node staging system for esophageal carcinoma to guide the surgery-based multidisciplinary treatment, and effectively to evaluate the therapeutic effects and predict patients' prognosis.
查看更多>>摘要：胃癌作为一种常见的消化道肿瘤，在全球范围内的发病及死亡情况仍不容乐观。尤其是进展期胃癌，患者的生存结局是临床重要的关注点，同样也是临床结局评估中重要的结局指标。本文通过对临床结局评估的定义及其在胃癌患者中可应用的测量工具进行综述，阐述临床结局评估工具的详细分类，并对临床结局评估在胃癌中的应用现状进行综述，分析其应用的效果及不足，以期为临床工作人员选择合适的工具提供参考，为推动精准医学的发展而进行全面、整体的临床结局评估提供帮助。 Gastric cancer is a common tumor of the gastrointestinal tract, and the global trend in morbidity and mortality are not encouraging. Especially in advanced gastric cancer, patient survival outcome is an essential clinical concern and a vital outcome indicator in clinical outcome assessment. This article reviews the definition of clinical outcome assessment and the measurement tools that can be applied in gastric cancer patients, describes the detailed classification of clinical outcome assessment tools, and reviews the current status of the application of clinical outcome assessment in gastric cancer, analyzing the effects and shortcomings of its application, to provide a reference for the clinical staff in choosing the appropriate tools, and assisting in the comprehensive and holistic assessment of clinical outcomes for the promotion of the development of precision medicine.
查看更多>>摘要：随着结直肠癌筛查的不断普及，筛查后人群的监测管理也成为结直肠癌防控的关键环节之一。近年来，针对筛查后人群的结直肠癌发病和死亡风险的研究证据不断涌现，同时，欧美国家的相关行业协会基于最新的研究证据，陆续更新了结肠镜检查和息肉切除术后的结肠镜监测指南。本文全面总结了目前关于结直肠癌筛查后人群的结直肠癌风险相关研究进展以及相关指南更新要点，以期为指导我国相关研究的开展以及监测指南或共识的制定提供参考。 With the widespread application of colorectal cancer screening, the surveillance and management of the increasing number of screened population has become a pivotal aspect in preventing and controlling colorectal cancer. In recent years, researches have been conducted on the risk of colorectal cancer incidence and mortality in the population after screening. At the same time, various organizations in Europe and the United States have continuously updated colonoscopy surveillance after screening and polypectomy based on the latest research evidence. In this review, we summarized the current progress of studies on colorectal cancer risk in post-screening colorectal cancer populations and the key points of relevant guideline updates, in order to provide a reference for conducting relevant studies and formulating surveillance guidelines or consensus in China.
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