CSCO结直肠癌诊疗指南(2019word版)

CSCOCSCO1AMeta80%1BMeta60%~80%2AMeta-80%CSCO1A2ACSCO1A2ACSCO1B2ACSCO1B2ACSCO2B32BMeta-60%~80%360%/1MDTMDTMDTMDTMDTMDT/1~21A.multidisciplinaryteamMDTMDT21.50~742.150~74511~33~51.2.1.1cm1~33~52.53.2~33~5+aa/CTb//CTc/MRICTdCEACA199X/USCTMRIeMRIefA.B./CTC.CTD./MRICTMRIT2DWIT1MRI1cmF.G.PET/CTPET/CT+ah+aCTbMRIiiCTj//CTc/MRICTdCEACA199XUSCTMRIeMRIefA.B./CTC.CTD./MRICTMRIT2DWIT1MRI1cmF.G.PET/CTPET/CTH.I.MRIMesorectalFasciaMRFMRITMRICTT2MRIJ.MRICT-TT1T2T3T3a1mmT3b1~5mmT3c5~15mmT3d15mmT4aT4bNMRI8mm/ExtramuralVascularInvasionEMVIMRIEMVIMRIEMVIcircumferentialresectionmarginCRMMRI/mesorectalfasciaMRF1mmCRMTT1T2T3T4ESMO-2017T1sm1cN0T1-T2/T3a/bN0N1MRF-EMVI-T2//T3a/bN1-2MRF-EMVI-T3/T3c/dN1-N2MRF-EMVI+T4//T3MRF+T4b+1.2018NCCNMRI2.//ESMO-20170~5cm5~10cm10~15cmMRFOVT2WITRGMandardTRGMRI/50%//a//lmismatchrepairMMRma,b////clMMRma,dhiflMSInTMEegTNMjTRGkMMRm/RASBRAFo,p,qA.30min%108~48hB.2~3mmC.1mmD.E.totalmesorectalexcisionTME1F.1mmG.1212H.WHO20102I.4WHO23pTNMAJCC/UICC8pTNMmryTNMK.TRGAJCC8TRG4L.CK7-/CK20+/CDX2+M.MMR4MMRMLH1MSH2MSH6PMS21dMMR4pMMRN.MSINCI5MSBAT25BAT26D5S346D2S123D17S2505MSS1MSI-L22MSI-HMSIMMRMMRMSIdMMRMSI-HpMMRMSI-LMSSKRASNRAS234BRAFV600EQ.DNAARMSHigh-throughputsequencingNext-generationsequencingtechnologyNGSNGS15mm5mm2WHO32412344TRG0*1*2*3TRG*UICC/AJCCTNM20178TNMTTxT0TisT1T2T3T4aT4bNNxN0N11~3TDtumordepositN1a1N1b2~3N1c/N24N2a4~6N2b7MMxM0M1M1aM1bM1c/N0N1N2aN2bT1AABT2ABBT3ABBCT4aBBCCT4bCCCCM1aAAAAM1bBBBBM1cCCCCTisT4bT4bcT4bpT3TDVLLVIPNIcTNMpTNMyypTNMypT0N0cM001rrTNM3T1T1N0a,b,c,d5~20mmaEMR~20mm2.10mm/3.20mmEMRESD20mmPEMReESD3.T1SM1mm4.20mm5.25mmESDfendoscopicmucosalresectionEMRendoscopicsubmucosaldissectionESDpiecemealendoscopicmucosalresectionPEMRA.15%T1SMCEACTC.T11mm1mmD.3~61E.PEMRPEMRF.apt1N0M0bpt1N0M0d+fpt1N0M0c+e,fdA.B.12C.1mm3/4/D.E.F.CT1-4N0-2M0~+aCT1-4N0-2M0~b,cdeA.B.+C.D.E.bT1-2N0M01Aa,b,e,f,g,hT3N0M0dMMR1AT3N0M0pMMRc1AT3N0M0/pMMRT4N0M0d1ApMMR1B3g,hTN+M0d1Ac1BA.T43/4MSI-H12MSI-HdMMRB.MOSAICFOLFOXC.5-FU/LVD.CapeOxXELOXmFOLFOX6E.MMR2.3dMMRMSI-H5-FUF.5-FU/LV70G.326IDEAT1-3N13CapeOXH.TAS-102pembrolizumabnivolumab1250mg/m221~143245-FU/LVsLV5FU2LV400mg/m22h15-FU400mg/m21200mg/m2d2d2400mg/m246~48h224CapeOxXELOX130mg/m22h11000mg/m221~14324mFOLFOX685mg/m22h1LV400mg/m22h15-FU400mg/m211200mg/m2d2d2400mg/m246~48h224T4bM0T4bM0a,b,cdeT4bM0+/-eT4bM0//+a,b,c//a,b,cT4bM0///+A.B.C.266~8D.T4bE.T4ba,bCRS0~2ce+d++e/f++d+/f+e+CRS3~5d++e/f++d+/f+ed/f+CRS0~2+e++d+/f+/d++e/f++CRS3~5+d+/f+e+d++e/f+A.R0B.5C.CRS121CEA200ng/ml5cm10~2CRS3~5CRSCRSD.2~3FOLFOX/CapeOxFOLFIRIE.F.RFASBRT//MDTa,b,cRASBRAFFOLFOX/FOLFIRId2AFOLFOX/CapeOx/FOLFIRI2AFOLFOXIRI2A2BFOLFOX/CapeOx/FOLFIRI2AFOLFOXIRI2AFOLFOX/FOLFIRId2BRASBRAFFOLFOX/CapeOx/FOLFIRI2AFOLFOXIRI2A2BcRASFOLFOX/FOLFIRId,eFOLFOX/CapeOx/FOLFIRI+1AFOLFOXIRIBRAFd1A1BFOLFOX/CapeOx/FOLFIRI1AFOLFOXIRI1BFOLFOX/FOLFIRId,e2ARASBRAF1Ad,ed2BFOLFOX/FOLFIRId,e2BFOLFOX/CapeOx/FOLFIRI2BPD-1MSI-HdMMR2A13RASBRAFFOLFOX/CapeOx/FOLFIRI1AFOLFOXIRI1BRASBRAF1AFOLFOX/CapeOx/FOLFIRI2BPD-1MSI-HdMMR2A13RASBRAFFOLFIRIff2Af2A+2A+i1BPD-13MSI-HdMMR2A1RASBRAFFOLFOXff2ACapeOxf1A+f2A+2APD-1MSI-HdMMR2A13RASBRAFFOLFIRIf1Af2A+2A+i1BPD-1MSI-HdMMR2A13++RAS/BRAFV600E2BmRASBRAFFOLFOX/CapeOxf1A+2A3FOLFOX/FOLFIRIf,gf,gf2A3f2ACapeOx2A+2A+i1BPD-1MSI-HdMMR2A1++RAS/BRAFV600E2BmRASBRAF1Ah1AjPD-1MSI-HdMMR2Ai33k1ARASBRAFh1Ak1AjPD-1MSI-HdMMR2Ai33++RAS/BRAFV600E2BmA.5-FU/LVFOLFOXIRIR0B.6~8C.R04~6R05-FU/LVD.RASEGFRVEGFE.F.BRAFH.20173CFDAVEGFEGFRCONCUR80mg/120mg/160mg/I.AXEPTFOLFIRI+UGT1A1*28*6J.HER2NGSK.20189CFDAVEGFEGFRRASL.MSI-H/dMMR2018NCCNMSI-H/dMMRPembrolizumabNivolumabM.BRAFV600E2018NCCN++RAS/BRAFV600EmFOLFOX685mg/m22h1LV400mg/m22h15-FU400mg/m211200mg/m2d2d2400mg/m246~48h2mFOLFOX6+85mg/m22h1LV400mg/m22h15-FU400mg/m211200mg/m2d2d2400mg/m246~48h5mg/kgIV12mFOLFOX6+85mg/m22h1LV400mg/m22h15-FU400mg/m211200mg/m2d2d2400mg/m246~48h2400mg/m2IV2h250mg/m2IV60min500mg/m2IV12h2CapeOx130mg/m2IV2h11000mg/m221~147d3CapeOx+130mg/m2IV2h11000mg/m221~147dkgIV13FOLFIRI180mg/m230~90min1LV400mg/m22h15-FU400mg/m211200mg/m2d2d2400mg/m246~48h2FOLFIRI+180mg/m230~90min1LV400mg/m22h15-FU400mg/m211200mg/m2d2d2400mg/m246~48h5mg/kg12FOLFIRI+180mg/m230~90min1LV400mg/m22h15-FU400mg/m211200mg/m2d2d2400mg/m246~48h2400mg/m2IV2h250mg/m2IV60min500mg/m2IV12h2CapIRI180mg/m230~90min11000mg/m221~72CapIRI+180mg/m230~90min11000mg/m221~75mg/kg12mXELIRI200mg/m230~90min1800mg/m221~143mXELIRI+200mg/m230~90min1800mg/m221~14kg13UGT1A1*28*6150mg/m21250mg/m221~143+1250mg/m221~143kgIV135-FU/LVsLV5FU2LV400mg/m22h15-FU400mg/m211200mg/m2d2d2400mg/m246~48h2FOLFOXIRI+165mg/m2185mg/m21LV400mg/m215-FU1600mg/m2d2d3200mg/m248h5mg/kgIV12125mg/m230~90min183300~350mg/m230~90min13+400mg/m2250mg/m21500mg/m221300~350mg/m23180mg/m22125mg/m2183