人民卫生出版社

中国临床肿瘤学会指南工作委员会组织（组织编写）

1　结直肠癌诊疗总则

结直肠癌的MDT诊疗模式

【注释】

a. 结直肠癌的诊治应重视多学科团队（multidisciplinary team，MDT）的作用，推荐有条件的单位将尽可能多的结直肠癌患者，尤其是转移性的结直肠癌患者的诊疗纳入MDT的管理。

b. MDT的实施过程中由多个学科的专家共同分析患者的临床表现、影像、病理和分子生物学资料，对患者的一般状况、疾病的诊断、分期/侵犯范围、发展趋向和预后作出全面的评估，并根据当前的国内外治疗规范/指南或循证医学依据，结合现有

2 结直肠癌的诊断原则 2.1无症状健康人员的结直肠癌筛查

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7. Sung JJ，Ng SC，Chan FK，et al. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening. Gut，2015，64（1）：121-132.

8. Lee JK，Liles EG，Bent S，et al. Accuracy of fecal immunochemical tests for colorectal cancer：systematic review and meta-analysis. Ann Intern Med，2014，160（3）：171.

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11. Park DI，Ryu S，Kim YH，et al. Comparison of guaiac-based and quantitative immunochemical fecal occult blood testing in a population at average risk undergoing colorectal cancer screening. Am J Gastroenterol，2010，105（9）：2017-2025.

12. Labianca R，Nordlinger B，Beretta GD，et al. Early colon cancer：ESMO Clinical Practice Guidelines for diagnosis，treatment and follow-up. Ann Oncol，2013，24 Suppl 6：vi64-72.

13. Halloran SP，Launoy G，Zappa M. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition--Faecal occult blood testing. Endoscopy，2012，44 Suppl 3：SE65-87.

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2 结直肠的诊断原则 2.2诊断基本原则

1. Floriani I，Torri V，Rulli E，et al. Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer：a systematic review and meta-analysis. Journal of Magnetic Resonance Imaging，2010，31（1）：19-31.

2. Valérie Vilgrain，Maxime Esvan，Maxime Ronot，et al. A meta-analysis of diffusion- weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases. Eur Radiol，2016，26（12）：4595-4615.

3. Moulton CA，Gu CS，Law CH，et al. Effect of PET before liver resection on surgical management for colorectal adenocarcinoma metastases：a randomized clinical trial. JAMA，2014，311：1863-1869.

4. Joyce DL，Wahl RL，Patel PV，et al. Preoperative positron emission tomography to evaluate potentially resectable hepatic colorectal metastases. Arch Surg，2006，141：1220-1226；discussion 1227.

5. Pelosi E，Deandreis D. The role of 18F-fluoro-deoxy-glucose positron emission tomography（FDG-PET）in the management of patients with colorectal cancer. Eur J Surg Oncol，2007，33：1-6.

6. Beets-Tan RG，Lambregts DM，Maas M，et al. Magnetic resonance imaging for the clinical management of rectal cancer patients：recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology（ESGAR）consensus meeting. Eur Radiol，2013，23：2522-2531.

7. Taylor FG，Quirke P，Heald RJ，et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence：5-year follow-up results of the MERCURY study. J Clin Oncol，2014，32：34-43.

8. Xie H，Zhou X，Zhuo Z，et al. Effectiveness of MRI for the assessment of mesorectal fascia involvement in patients with rectal cancer：a systematic review and meta-analysis. Dig Surg，2014，31：123-134.

9. Bipat S，Glas AS，Slors FJM，et al. Rectal cancer：local staging and assessment of lymph node involvement with endoluminal US，CT，and MR imaging--a meta-analysis. Radiology，2004，232：773-783.

10. Nougaret S1，Reinhold C，Mikhael HW，et al. The use of MR imaging in treatment planning for patients with rectal carcinoma：have you checked the“DISTANCE”? Radiology，2013，268（2）：330-344.

11. Al-Sukhni E，Milot L，Fruitman M，et al. Diagnostic accuracy of MRI for assessment of T category，lymph node metastases，and circumferential resection margin involvement in patients with rectal cancer：a systematic review and meta-analysis. Annals of surgical oncology，2012，19：2212-2223.

12. Chand，M，Evans J，Swift RI，et al. The prognostic significance of postchemoradiotherapy highresolution MRI and histopathology detected extramural venous invasion in rectal cancer. Annals of surgery，2015，261：473-479.

13. Battersby NJ，How P，Moran B，et al. Prospective Validation of a Low Rectal Cancer Magnetic Resonance Imaging Staging System and Development of a Local Recurrence Risk Stratification Model：The MERCURY II Study. Annals of surgery，2016，263：751-760.

14. Battersby NJ1，Moran B，Yu S，Tekkis P，Brown G. MR imaging for rectal cancer：the role in staging the primary and response to neoadjuvant therapy. Expert Rev Gastroenterol Hepatol. 2014 Aug；8（6）：703-719.

15. Glynne-Jones R，Wyrwicz L，Tiret E，et al. Rectal cancer：ESMO Clinical Practice Guidelines for diagnosis，treatment and follow-up. Ann Oncol 28（Supple 4）：iv22-iv40，2017；doi：10. 1093/annonc/mdx224）.

16. Patel UB，Taylor F，Blomqvist L，et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes：MERCURY experience. Journal of clinical oncology，2011，29：3753-3760.

2 结直肠癌的诊断原则 2.3 病理学诊断原则

1. Cooper HS.Pathology of endoscopically removed malignant colorectal polyp. Curr Diagn Pathol，2007，13（6）：423-437.

2. Benson AB，Venook AP，Bekaii-Saab T，et al. NCCN Clinical Practice Guidelines in Onclology：Rectal Cancer，Version 3.2015.

3. Parfitt JR，Driman DK. The total mesorectal excision specimen for rectal cancer：a review of its pathological assessment. J Clin Pathol，2007，60：849-855.

4. Nagtegaal ID，Marijnen CA，Kranenbarg EK，et al. Pathology Review Committee；Cooperative Clinical Investigators. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma：not one millimeter but two millimeters is the limit. Am J Surg Pathol，2002，26（3）：350-357.

5. Bosman FT，Carneiro F，Hruban RH，et al. WHO Classification of Tumours of the Digestive System，4th Edition. Geneva，Switzerland：WHO Press，2010，137.

6. Amin MB，Edge SB，Greene FL，et al. AJCC Cancer Staging Manual（8th Edition）. Chicago：Springer，2017.

2 结直肠癌的诊断原则 2.4 分期

1. Amin MB，Edge SB，Greene FL，et al. AJCC Cancer Staging Manual（8th Edition）. Chicago：Springer，20

3.1.1.1.1内镜治疗策略

1. Tanaka S，Kashida H，Saito Y，et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Digestive Endoscopy，2015，27（4）：417-434.

2. Fujiya M，Tanaka K，Dokoshi T，et al. Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms：a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc，2015，81（3）：583-595.

3. Watanabe T，Muro K，Ajioka Y，et al. Japanese Society for Cancer of the Colon and Rectum（JSCCR）guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol，2017.

4. De Ceglie A，Hassan C，Mangiavillano B，et al. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions：A systematic review. Critical Reviews in Oncology/Hematology，2016，104：138-155.

5. Ferlitsch M，Moss A，Hassan C，et al. Colorectal polypectomy and endoscopic mucosal resection（EMR）：European Society of Gastrointestinal Endoscopy（ESGE）Clinical Guideline. Endoscopy，2017，49（3）：270-297.

6. Ribeiro MS，Wallace MB. Endoscopic Treatment of Early Cancer of the Colon. Gastroenterol Hepatol（NY），2015，11（7）：445-452.

3.1.1.1.2 息肉镜下切除术后的处理策略

1. Cooper HS，Deppisch LM，Gourley WK，et al. Endoscopically removed malignant colorectal polyps：clinicopathologic correlations. Gastroenterology，1995，108：1657-1665.

2. Seitz U，Bohnacker S，Seewald S，et al. Is endoscopic polypectomy an adequate therapy for malignant colorectal adenomas? Presentation of 114 patients and review of the literature. Dis Colon Rectum，2004，47：1789-1796.

3. Volk EE，Goldblum JR，Petras RE，et al. Management and outcome of patients with invasive carcinoma arising in colorectal polyps. Gastroenterology，1995，109：1801-1807.

4. Markowitz AJ，Winawer SJ. Management of colorectal polyps. CA Cancer J Clin，1997，47：93-112.

5. Yoshii S，Nojima M，Nosho K，et al. Factors associated with risk for colorectal cancer recurrence after endoscopic resection of T1 tumors. Clin Gastroenterol Hepato，2014，12：292-302 e293.

6. Cooper HS. Surgical pathology of endoscopically removed malignant polyps of the colon and rectum. Am J Surg Pathol，1983，7：613-623.

7. Hassan C，Zullo A，Risio M，et al. Histologic risk factors and clinical outcome in colorectal malignant polyp：a pooled-data analysis. Dis Colon Rectum，2005，48：1588-1596.

8. Cranley JP，Petras RE，Carey WD，et al. When is endoscopic polypectomy adequate therapy for colonic polyps containing invasive carcinoma? Gastroenterology，1986，91：419-427.

9. Haggitt RC，Glotzbach RE，Soffer EE，Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas：implications for lesions removed by endoscopic polypectomy. Gastroenterology，1985，89：328-336.

3.1.1.2 手术治疗

1. Cohen AM. Surgical considerations in patients with cancer of the colon and rectum. Semin Oncol，1991，18：381-387.

2. West NP，Hohenberger W，Weber K，et al. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol，2010，28：272-278.

3. Amin MB，Edge SB，Greene FL，et al. AJCC Cancer Staging Manual（8th Edition）. Chicago：Springer，2017.

4. Berger AC，Sigurdson ER，LeVoyer T，et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J ClinOncol，2005，23：8706-8712.

5. Huang X，Lv B，Zhang S，Meng L. Preoperative colonic stents versus emergency surgery for acute leftsided malignant colonic obstruction：a meta-analysis. J Gastrointest Surg，2014，18：584-591.

3.1.1.3 术后辅助化疗

1. Colon Cancer，Version 2，2016.Clinical Practice Guidelines in Oncology（NCCN Guidelines ）. www.nccn.org.

2. Tournigand C，André T，Bonnetain F，et al. Adjuvant therapy with fluorouracil and oxaliplatin in stage II and elderly（between ages 70 and 75 years）with colon cancer：a subgroup analyses of the Multicenter International Study of Oxaliplatin，Fluorouracil，and Leucovorin in the Adjuvant Treatment of Colon Cancer trial. J Clin Oncol，2012，20；30（27）：3353-3360.

3. Sargent DJ，Marsoni S，Monges G，et al. Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil based adjuvant therapy in colon cancer. J Clin Oncol，2010，28：3219-3226.

3.1 非转移性结肠癌的治疗

1. Chibaudel B，C Tournigand，F Bonnetain，et al. Therapeutic strategy in unresectable metastatic colorectal cancer：an updated review. Ther Adv Med Oncol，2015，7（3）：153-169.

2. Saltz LB，S Clarke，E Diaz-Rubio，et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer：a randomized phase III study. J Clin Oncol，2008，26（12）：2013-2019.

3. Loupakis F，C Cremolini，G Masi，et al. Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer. N Engl J Med，2014，371（17）：1609-1618.

4. Tebbutt NC，K Wilson，VJ Gebski，et al. Capecitabine，bevacizumab，and mitomycin in firstline treatment of metastatic colorectal cancer：results of the Australasian Gastrointestinal Trials Group Randomized Phase III MAX Study. J Clin Oncol，2010，28（19）：3191-3198.

5. Kabbinavar FF，J Schulz，M McCleod，et al. Addition of bevacizumab to bolus fluorouracil and leucovorin in first-line metastatic colorectal cancer：results of a randomized phase II trial. J Clin Oncol，2005，23（16）：3697-3705.

6. Hecht J R，E Mitchell，T Chidiac，et al. A randomized phase IIIB trial of chemotherapy，bevacizumab，and panitumumab compared with chemotherapy and bevacizumab alone for metastatic colorectal cancer. J Clin Oncol，2009，27（5）：672-680.

7. Tol J，M Koopman，A Cats，et al. Chemotherapy，bevacizumab，and cetuximab in metastatic colorectal cancer. N Engl J Med，2009，360（6）：563-572.

8. Qiu B，PR Ding，L Cai，et al. Outcomes of preoperative chemoradiotherapy followed by surgery in patients with unresectable locally advanced sigmoid colon cancer. Chin J Cancer，2016，35（1）：65.

9. Lee J M，J S Byeon. Colorectal Stents：Current Status. Clin Endosc，2015，48（3）：194-200.

10. Cetinkaya E，AB Dogrul，MB Tirnaksiz. Role of self expandable stents in management of colorectal cancers. World J Gastrointest Oncol，2016，8（1）：113-120.

3.2.1.1 初始可切除转移性结肠癌的治疗a，b

1. Hamady Z Z，Cameron I C，Wyatt J，et al. Resection margin in patients undergoing hepatectomy for colorectal liver metastasis：a critical appraisal of the 1cm rule. Eur J Surg Oncol，2006，32（5）：557-563.

2. Fong Y，Fortner J，Sun R L，et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer：analysis of 1001 consecutive cases. Ann Surg，1999，230（3）：309-321.

3. Ayez N，van der Stok E P，Grunhagen D J，et al. The use of neo-adjuvant chemotherapy in patients with resectable colorectal liver metastases：Clinical risk score as possible discriminator. Eur J Surg Oncol，2015，41（7）：859-867.

4. Cutsem E V，Cervantes A，Adam R，et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol，2016，27（8）：1386-1422.

3.2.1.2 初始不可切除转移性结肠癌的治疗

1. Colon Cancer，Version 1，2017. Clinical Practice Guidelines in Oncology（NCCN Guidelines ），www.nccn.org

2. Alberts SR，Horvath WL，Sternfeld WC，et al. Oxaliplatin，fluorouracil，and leucovorin for patients with unresectable liver-only metastases from colorectal cancer：a North Central Cancer Treatment Group phase II study. J Clin Oncol，2005，23（36）：9243-9249.

3. Falcone A，Ricci S，Brunetti I，et al. Phase III trial of infusional fluorouracil，leucovorin，oxaliplatin，and irinotecan（FOLFOXIRI）compared with infusional fluorouracil，leucovorin，and irinotecan（FOLFIRI）as frst-line treatment for metastatic colorectal cancer：the Gruppo Oncologico Nord Ovest. J Clin Oncol，2007，25：1670-1676.

4. Yaicin S，Uslu R，Dane F，et al. Bevacizumab + Capecitabine as Maintenance Therapy after Initial Bevacizumab + XELOX Treatment in Previously Untreated Patients with Metastatic Colorectal Cancer：Phase III ‘Stop and Go’ Study Results - A Turkish Oncology Group Trial. Oncology，2013，85：328-335.

5. Esin E，Yalcin S. Maintenance strategy in metastatic colorectal cancer：A systematic review. Cancer Treament Reviews，2016，42：82-90.

6. Tejpar S，SStintzing S，Ciardiello F，et al. Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metasticic colorectal cancer. JAMA Oncol，2016，doi. 10001 /jamaoncol.2016. 3797.

7. Masi G，Salvatore L，Boni L，et al. Continuation or reintroduction of bevacizumab beyond progression to first-line therapy in metastatic colorectal cancer：final results of the randomized BEBYP trial. Ann Oncol，2015，26：724-730.

8. Li J，Qin S，Xu R，et al. Regorafenib plus best supportive care versus placebo plus best supportive care in Asian patients with previously treated metastatic colorectal cancer（CONCUR）：a randomised，double-blind，placebo-controlled，phase 3 trial. Lancet Oncol，2015，16（6）：619-629.

9. Suenaga M，Mizunuma N，Matsusaka S，et al. A phase I/II study of biweekly capecitabine and irinotecan plus bevacizumab as second-line chemotherapy in patients with metastatic colorectal cancer. Drug Des Devel Ther，2015，16；9：1653-1662.

10. Xu RH, Muro K, Morita S, et al. Modified XELIRI（capecitabine plus irinotecan）versus FOLFIRI （leucovorin,fluorouracil, and irinotecan）, both either with or without bevacizumab, as second-line therapy for metastatic colorectal cancer（AXEPT）： a multicentre, open-lable, randomised, non-inferiority, phase 3 trial. Lancet Oncol,2018, doi：https：//doi. org/10. 1016/S1470-2045（18）30140-2.

3.3 结肠癌的随访

1. Rex DK，Kahi CJ，Levin B，et al. Guidelines for colonoscopy surveillance after cancer resection：a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology，2006，130：1865-1871.

4.1.1 直肠腺瘤治疗原则a，c

1. Al-Najami I，Rancinger C P，Larsen M K，et al. Transanal endoscopic microsurgery for advanced polyps and early cancers in the rectum-Long-term outcome：A STROBE compliant observational study. Medicine（Baltimore），2016，95（36）：e4732.

2. Tanaka S，Kashida H，Saito Y，et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Digestive Endoscopy，2015，27（4）：417-434.

4.1.2 c T1-2NO直肠癌的治疗原则

1. Heald RJ，Husband EM，Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg，1982，69：613-616.

2. Nascimbeni R，Burgart LJ，Nivatvongs S，Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum，2002，45：200-206.

3. Yamamoto S，Watanabe M，Hasegawa H，et al. The risk of lymph node metastasis in T1 colorectal carcinoma. Hepatogastroenterology，2004，51：998-1000.

4. Smith JJ，Chow OS，Gollub MJ，et al. Organ Preservation in Rectal Adenocarcinoma：a phase II randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy，and total mesorectal excision or nonoperative management. BMC Cancer，2015，15：767. Doi：10. 1186/s12885-015-1632-z

4.1.3 cT3/cT4 N+直肠癌的治疗原则

1. Sauer R，Becker H，Hohenberger W，et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med，2004，351：1731-1740.

2. Sauer R，Liersch T，Merkel S，et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer：results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol，2012，30：1926-1933.

3. Wagman R，Minsky BD，Cohen AM，et al：Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis：long term follow-up. Int J Radiat Oncol Biol Phys，1998，42：51-57.

4. Gerard JP，Conroy T，Bonnetain F，et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers：results of FFCD 9203. J Clin Oncol，2006，24：4620-4625.

5. Bosset JF，Calais G，Mineur L，et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer：preliminary results--EORTC 22921. J Clin Oncol，2005，23：5620-5627.

6. Bosset JF，Collette L，Calais G，et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med，2006，355：1114-1123.

7. De Caluwe L，Van Nieuwenhove Y，Ceelen WP. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev：CD006041

8. Hofheinz RD，Wenz F，Post S，et al. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer：a randomised，multicentre，non-inferiority，phase 3 trial. Lancet Oncol，2012，13：579-588.

9. O'Connell MJ，Colangelo LH，Beart RW，et al. Capecitabine and oxaliplatin in the preoperative multimodality treatment of rectal cancer：surgical end points from National Surgical Adjuvant Breast and Bowel Project trial R-04. J Clin Oncol，2014，32：1927-1934.

10. Aschele C，Cionini L，Lonardi S，et al. Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer：pathologic results of the STAR-01 randomized phase III trial. J Clin Oncol，2011，29：2773-2780.

11. Gerard JP，Azria D，Gourgou-Bourgade S，et al. Clinical outcome of the ACCORD 12/0405 PRODIGE 2 randomized trial in rectal cancer. J Clin Oncol，2012，30：4558-4565.

12. Rodel C，Liersch T，Becker H，et al. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer：initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol，2012，13（7）：679-687.

13. Gay HA，Barthold HJ，O'Meara E，et al. Pelvic normal tissue contouring guidelines for radiation therapy：a Radiation Therapy Oncology Group consensus panel atlas. Int J Radiat Oncol Biol Phys，2012，83（3）：e353-362.

14. Cedermark B，Dahlberg M，Glimelius B，et al. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med，1997，336：980-987.

15. van Gijn W，Marijnen CA，Nagtegaal ID，et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer：12-year follow-up of the multicentre，randomised controlled TME trial. Lancet Oncol，2011，12：575-582.

16. Bujko K，Nowacki MP，Nasierowska-Guttmejer A，et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg，2006，93：1215-1223.

17. Ngan SY，Burmeister B，Fisher RJ，et al. Randomized trial of short-course radiotherapy versus longcourse chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer：Trans-Tasman Radiation Oncology Group trial 01. 04. J Clin Oncol，2012，30：3827-3833.

18. Andre T，Boni C，Mounedji-Boudiaf L，et al. Oxaliplatin，fluorouracil，and leucovorin as adjuvant treatment for colon cancer. N Engl J Med，2004，350：2343-2351.

19. Hong YS，Nam BH，Kim KP et al. Oxaliplatin，fluorouracil，and leucovorin versus fluorouracil and leucovorin as adjuvant chemotherapy for locally advanced rectal cancer after preoperative chemoradiotherapy（ADORE）：an open-label，multicentre，phase 2，randomised controlled trial.Lancet Oncol，2014，15：1245-1253.

20. Fernandez-Martos C，Pericay C，Aparicio J，et al. Phase II，randomized study of concomitant chemoradiotherapy followed by surgery and adjuvant capecitabine plus oxaliplatin（CAPOX）compared with induction CAPOX followed by concomitant chemoradiotherapy and surgery in magnetic resonance imaging-defined，locally advanced rectal cancer：Grupo cancer de recto 3 study. J Clin Oncol，2010，28：859-865.

21. Marechal R，Vos B，Polus M，et al. Short course chemotherapy followed by concomitant chemoradiotherapy and surgery in locally advanced rectal cancer：a randomized multicentric phase II study. Ann Oncol，2005，23：1525-1530.

4.2.2.1 直肠癌术后局部复发的诊疗原则

1. Boyle KM，Sagar PM，Chalmers AG，et al. Surgery for locallyrecurrent rectal cancer. Dis Colon Rectum，2005，48：929-937.

2. Hahnloser D，Nelson H，Gunderson LL，et al. Curative potentialof multimodality therapy for locally recurrent rectal cancer. AnnSurg，2003，237：502-508.

3. Moore HG，Shoup M，Riedel E，et al. Colorectal cancer pelvicrecurrences：determinants of resectability.Dis Colon Rectum，2004，47：1599-1606.

4. Heriot Ag，Byrne CM，Dobbs B，et al. Extended radical resection：the choice for locally recurrent rectal cancer. Dis Colon Rectum，2008，51：284-291.

5. Yamada K，Ishizawa T，Niwa K，et al. Pelvic exenteration andsacral resection for locally advancedprimary and recurrent rectalcancer. Dis Colon Rectum，2002，45：1078-1084.

6. Bouchard P，Efron J. Management of Recurrent Rectal Cancer. Ann SurgOncol，2010，17：1343-1356.

7. Mirnezami AH，Sagar PM，Kavanagh D，et al. Clinical Algorithms for the Surgical Management of Locally Recurrent Rectal Cancer. Dis Colon Rectum，2010，53：1248-1257.

8. 陈功. 直肠癌局部复发的多学科综合诊治进展. 中国普外基础与临床杂志，2013，20（11）：1208-1216.

4.3 直肠癌的随访

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5 遗传性结直肠癌筛检和基因诊断原则

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2. Grover S，Kastrinos F，Steyerberg EW，et al. Prevalence and phenotypes of APC and MUTYH mutations in patients with multiple colorectal adenomas. JAMA，2012，308（5）：485-492.

3. 杨邵瑜，蔡善荣，张苏展. 家族性腺瘤性息肉病及其亚型的临床及遗传表型. 实用肿瘤杂志，2007，（3）：270-273.

4. Nieuwenhuis MH，Vasen HF. Correlations between mutation site in APC and phenotype of familial adenomatous polyposis（FAP）：a review of the literature. Crit Rev Oncol Hematol，2007，61（2）：153-161.

5. 丁衍，许预，徐晓东. 家族性腺瘤性息肉病患者中先天性视网膜色素上皮肥厚的FFA研究. 国际眼科杂志，2010，10（6）：1157-1159.

6. 楼征，于恩达，孟荣贵. 家族性腺瘤性息肉病相关性硬纤维瘤病. 第二军医大学学报，2006，（5）：541-543.

7. 曹海龙，王邦茂，曹晓沧. Gardner和Turcot综合征的临床特点93例. 世界华人消化杂志，2010，18（36）：3922-3925.

8. Sieber OM，Lipton L，Crabtree M，et al. Multiple colorectal adenomas，classic adenomatous polyposis，and germ-line mutations in MYH. N Engl J Med，2003，348（9）：791-799.

9. 袁瑛，曹文明，蔡善荣，张苏展. 中国人遗传性非息肉病性结直肠癌家系的临床表型分析. 中华肿瘤杂志，2006，28（1）：36-38.

10. Lindor NM，Rabe K，Petersen GM，et al. Lower cancer incidence in Amsterdam-I criteria families without mismatch repair deficiency：familial colorectal cancer type X. JAMA，2005，293（16）：1979-1985.

11. 李晓芬，袁瑛. 中国 Lynch 综合征的过去、现在和将来. 中华结直肠疾病电子杂志，2015，（3）：21-26.

12. Moreira L，Balaguer F，Lindor N，et al. Identification of Lynch syndrome among patients with colorectal cancer. JAMA，2012，308（15）：1555-1565.

13. 全国遗传性大肠癌协作组. 中国人遗传性大肠癌筛检标准的实施方案. 中华肿瘤杂志，2004，26（3）：191-192.

14. Ligtenberg MJ，Kuiper RP，Chan TL，et al. Heritable somatic methylation and inactivation of MSH2 in families with Lynch syndrome due to deletion of the 3' exons of TACSTD1. Nat Genet，2009，41（1）：112-117.

15. Senter L，Clendenning M，Sotamaa K，et al. The clinical phenotype of Lynch syndrome due to germline PMS2 mutations. Gastroenterology，2008，135（2）：419-428.

16. Hampel H，Frankel WL，Martin E，et al. Screening for the Lynch syndrome（hereditary nonpolyposis colorectal cancer）. N Engl J Med，2005，352（18）：1851-1860.

17. 王石林，笪冀平，顾国利. Muir-Torre综合征的研究进展. 中国普外基础与临床杂志，2005，12（2）：192-194.

18. Xicola RM，Llor X，Pons E，et al. Performance of different microsatellite marker panels for detection of mismatch repair-deficient colorectal tumors. J Natl Cancer Inst，2007，99（3）：244-252.

19. Boland CR，Thibodeau SN，Hamilton SR，et al. A National Cancer Institute Workshop on Microsatellite Instability for cancer detection and familial predisposition：development of international criteria for the determination of microsatellite instability in colorectal cancer. Cancer Res，1998，58（22）：5248-5257.

20. 朱明，刘晓蓉，黄彦钦等. 中国人家族性结直肠癌错配修复基因大片段变异分析. 中华医学遗传学杂志，2005，22（6）：603-606.

21. 戴益琛，谢军培，曾伟，傅玉卡，陈章兴. 中国大陆黑斑息肉综合征临床荟萃分析. 临床内科杂志，2008，25（8）：526-527.

22. 康连春，赵喜荣，周永双等. STK11基因在Peutz-Jeghers综合征家系中的突变分析. 科学通报，2002，47（21）：1639-1643.

23. 中国抗癌协会大肠癌专业委员会遗传学组. 遗传性结直肠癌临床诊治和家系管理中国专家共识.中华肿瘤杂志，2018，40（1）：64-77.