确诊了肠癌,到底能活多久?
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">按照</span>最新的美国肿瘤<span style="color: black;">病人</span>的统计数据<span style="color: black;">表示</span>(<span style="color: black;">病人</span>数据为2011-2017年,<span style="color: black;">由于</span>要<span style="color: black;">跟踪</span>5年<span style="color: black;">存活</span>率):</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">局限性结直肠癌<span style="color: black;">病人</span>(类似于<span style="color: black;">咱们</span>说的<span style="color: black;">初期</span>),5年<span style="color: black;">存活</span>率大约为91%,<span style="color: black;">亦</span><span style="color: black;">便是</span>说能活过5年的概率大约是91%;</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">区域性结直肠癌<span style="color: black;">病人</span>(类似于<span style="color: black;">咱们</span>说的中期或局部晚期),5年<span style="color: black;">存活</span>率大约为72%;</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">而一旦有了远处转移(即晚期或转移性结直肠癌),<span style="color: black;">病人</span>的5年<span style="color: black;">存活</span>率骤降至15%。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-8af99b9c0e5dca0311ffd956bec1b5b9_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>数据<span style="color: black;">源自</span>:Cancer statistics, 2022<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但<span style="color: black;">必须</span><span style="color: black;">尤其</span>指出的是,<span style="color: black;">倘若</span><span style="color: black;">病人</span>仅<span style="color: black;">显现</span>了肝转移或肺转移,且判定为可切除或潜在可切除,<span style="color: black;">病人</span>还是有治愈的机会,预期<span style="color: black;">存活</span>远远好于肠癌肝转移不可切除的<span style="color: black;">病人</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">而随着晚期结直肠癌基因分型的<span style="color: black;">精细</span>化,以及新药和新治疗<span style="color: black;">方法</span>的<span style="color: black;">持续</span><span style="color: black;">开发</span>和验证,<span style="color: black;">日前</span>即便是晚期结直肠癌<span style="color: black;">病人</span>,经过标准化且<span style="color: black;">连续</span>性的治疗,<span style="color: black;">亦</span>能达到3年、<span style="color: black;">乃至</span>4年的中位总<span style="color: black;">存活</span>期。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一旦确诊晚期结直肠癌,<span style="color: black;">意见</span>尽快进行基因检测,<span style="color: black;">按照</span>不同病理分型<span style="color: black;">选取</span>不同治疗策略。</p>RAS/BRAF野生型,预期<span style="color: black;">存活</span>好,左半<span style="color: black;">选取</span>西妥昔单抗+化疗,右半<span style="color: black;">选取</span>贝伐+化疗(<span style="color: black;">倘若</span>以缩瘤为目的,<span style="color: black;">亦</span>可选择西妥昔单抗联合化疗)RAS突变型,<span style="color: black;">日前</span>KRAS G12C突变<span style="color: black;">已然</span>有相应的靶向<span style="color: black;">药品</span>可供治疗BRAF V600E 突变型,一线为三药化疗±贝伐,二线双靶联合<span style="color: black;">方法</span>(BRAF<span style="color: black;">控制</span>剂+西妥昔单抗)<span style="color: black;">已然</span><span style="color: black;">作为</span>标准MSI-H或dMMR,<span style="color: black;">能够</span><span style="color: black;">不消</span>化疗了,直接<span style="color: black;">运用</span>免疫治疗(帕博利珠单抗 <span style="color: black;">或</span> 纳武利尤单抗±伊匹木单抗)HER2扩增型,抗HER2双靶治疗 <span style="color: black;">或</span> ADC<span style="color: black;">已然</span>可应用于临床治疗<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-5b39130c9ad9b26d795c66f4e4b02bbd_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>Biller LH,Schrag D. JAMA. 2021;325(7):669 685.<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-00f46f720bd63b3ead87965e15f0e2be_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>数据<span style="color: black;">源自</span>:Cancer statistics, 2022<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">正如上图所示,不论是男性还是女性,每年<span style="color: black;">由于</span>结直肠癌而死亡的<span style="color: black;">病人</span>人数呈逐年下降的趋势,不仅得益于外科技术和<span style="color: black;">精细</span>治疗从理念转化为真正临床治疗实践的进步,还得益于肠镜等筛查手段的推广和普及。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">想<span style="color: black;">认识</span><span style="color: black;">更加多</span>晚期结直肠癌的<span style="color: black;">精细</span>治疗么?</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">请关注ACEoncology的知乎/<span style="color: black;">微X</span>号,<span style="color: black;">更加多</span>肿瘤<span style="color: black;">关联</span>知识与您分享!</p>
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