Table CDR62726 Rectal Cancer Treatment/直肠癌治疗
ID Type Description_en Description_zh
w1 Word Lipoma 脂肪瘤
w2 Word Melanoma 黑色素瘤
w3 Word Cetuximab 西妥昔单抗
w4 Word Oxaliplatin 奥沙利铂
w5 Word Anatomy ​解剖学
w6 Word Leiomyoma 平滑肌瘤
w7 Word Villous 绒毛状
w8 Word Weakness 乏力
w9 Word Tubular 管状
w10 Word Leiomyosarcoma 平滑肌肉瘤
w11 Word Panitumumab 帕尼单抗
w12 Word Epidemiology ​流行病学
w13 Word Capecitabine 卡培他滨
w14 Word Serrated 锯齿状
w15 Word Tubulovillous 绒毛管状
w16 Word rectal cancer 直肠癌
w17 Word Kaposi sarcoma 卡波西肉瘤
w18 Word Weight loss ​体重下降
w19 Word Mucinous adenocarcinoma 粘液腺癌
w20 Word Burkitt lymphoma Burkitt淋巴瘤
w21 Word Medullary carcinoma 髓样癌
w22 Word Treatment Toxicity 治疗毒性
w23 Word Gastrointestinal bleeding ​消化道出血
w24 Word Undifferentiated carcinoma 未分化癌
w25 Word Nonepithelial Tumors 非上皮性肿瘤
w26 Word Adjuvant oxaliplatin 奥沙利铂辅助化疗
w27 Word Intestinal obstruction ​肠梗阻
w28 Word Palliative chemoradiation 姑息性放化疗
w29 Word Liver metastases ​肝转移
w30 Word Fluorouracil (5-FU) 氟尿嘧啶（5-FU）
w31 Word Palliative chemotherapy 姑息性化疗
w32 Word Epithelial Tumors 上皮性肿瘤
w33 Word Abdominal pain ​腹痛
p1 Phrase Arm B: fluoropyrimidine/oxaliplatin/cetuximab B组：氟嘧啶/奥沙利铂/西妥昔单抗
p2 Phrase Endocavitary radiation therapy 盆腔内放疗
p3 Phrase Definitions of TNM TNM分期的定义
p4 Phrase Gastrointestinal stromal tumor 胃肠道间质瘤
p5 Phrase Arm A: fluoropyrimidine/oxaliplatin A组：氟嘧啶/奥沙利铂
p6 Phrase Incidence and Mortality ​发病率与死亡率
p7 Phrase Local radiation therapy 局部放疗
p8 Phrase Mantle cell lymphoma 套细胞淋巴瘤
p9 Phrase Preoperative Chemoradiation Therapy 术前放化疗
p10 Phrase recurrent rectal cancer 复发性直肠癌
p11 Phrase Burkitt-like/atypical Burkitt lymphoma 类Burkitt、不典型Burkitt淋巴瘤
p12 Phrase Metastatic Rectal Cancer 转移性直肠癌
p13 Phrase Change in appetite 食欲改变
p14 Phrase Genetic risk factors ​遗传性危险因素
p15 Phrase First-line multiagent chemotherapy 一线多药化疗
p16 Phrase A clinical trial 参加临床试验
p17 Phrase Prone patient positioning 患者俯卧位
p18 Phrase Palliative radiation therapy 姑息性放疗
p19 Phrase Signet-ring cell carcinoma 印戒细胞癌
p20 Phrase Other risk factors ​其他危险因素
p21 Phrase Rectal Cancer (PDQ®): Treatment 直肠癌（PDQ®）：治疗
p22 Phrase stage III rectal cancer III期直肠癌
p23 Phrase stage I rectal cancer I期直肠癌
p24 Phrase Hereditary mixed polyposis syndrome 遗传性混合性息肉病综合征
p25 Phrase Stage II Rectal Cancer II期直肠癌
p26 Phrase Clinical Presentation and Symptoms 临床表现与症状
p27 Phrase Capecitabine with radiation therapy 卡培他滨联合放疗
p28 Phrase Systemic chemotherapy (see below) 全身化疗（详见下文）
p29 Phrase Locally Recurrent Rectal Cancer 局部复发性直肠癌
p30 Phrase Stage I Rectal Cancer I期直肠癌
p31 Phrase Change in bowel habits ​排便习惯改变
p32 Phrase Clinical Evaluation and Staging 临床评估与分期
p33 Phrase Arm C: intermittent fluoropyrimidine/oxaliplatin C组：间歇性氟嘧啶/奥沙利铂
p34 Phrase Cowden syndrome: PTEN gene ​Cowden综合征：PTEN基因
p35 Phrase stage IV rectal cancer IV期直肠癌
p36 Phrase Low-grade glandular intraepithelial neoplasia 低级别腺上皮内瘤变
p37 Phrase Cetuximab/Panitumumab and Second-Line Chemotherapy 西妥昔单抗/帕尼单抗与二线化疗
p38 Phrase Table 1. Primary Tumor 表1.原发肿瘤
p39 Phrase stage II rectal cancer II期直肠癌
p40 Phrase stage 0 rectal cancer 0期直肠癌
p41 Phrase Genetics of Colorectal Cancer 结直肠癌的遗传学
p42 Phrase High-grade glandular intraepithelial neoplasia 高级别腺上皮内瘤变
p43 Phrase Stage 0 Rectal Cancer 0期直肠癌
p44 Phrase Ruvalcaba–Myhre–Smith syndrome: PTEN gene ​Ruvalcaba-Myher-Smith综合征：PTEN基因
p45 Phrase Tumor invades muscularis propria 肿瘤侵犯固有肌层
p46 Phrase Addition of radiation therapy 添加放疗
p47 Phrase Diffuse large B-cell lymphoma 弥漫性大B细胞淋巴瘤
p48 Phrase Stage III Rectal Cancer III期直肠癌
p49 Phrase Enterochromaffin (EC)-cell, serotonin-producing neoplasm 分泌血清素的肠嗜铬细胞（EC）瘤
p50 Phrase Oxaliplatin with chemoradiation therapy 奥沙利铂联合放化疗
p51 Phrase General Information About Rectal Cancer ​直肠癌的基本信息
p52 Phrase Polypectomy for select T1 cancers 对T1期肿瘤行选择性息肉切除术
p53 Phrase No regional lymph node metastasis 区域淋巴结无转移
p54 Phrase Clinical trials evaluating new drugs 新药评估临床试验
p55 Phrase Table 4. Anatomic Stage/Prognostic Groups 表4.解剖分期/预后分组
p56 Phrase Chemotherapy alone for local control 单用化疗以进行局部控制
p57 Phrase Stage Information for Rectal Cancer 直肠癌的分期信息
p58 Phrase German Rectal Cancer Study Group 德国直肠癌研究组
p59 Phrase Local excision or simple polypectomy 局部切除术或单纯息肉切除术
p60 Phrase Peutz-Jeghers syndrome: STK11 / LKB1 gene ​Peutz-Jeghers综合征：STK11/LKB1基因
p61 Phrase Turcot syndrome: APC gene; MMR genes ​Turcot综合征：APC基因，MMR基因
p62 Phrase Metastases in 4–6 regional lymph nodes 4-6枚区域淋巴结转移
p63 Phrase Metastases in ≥7 regional lymph nodes ≥7枚区域淋巴结转移
p64 Phrase The use of high-energy radiation machines 使用高能量的放疗仪器
p65 Phrase Familial adenomatous polyposis (FAP): APC gene ​家族性腺瘤性息肉病（FAP）：APC基因
p66 Phrase Metastases in 1–3 regional lymph nodes 1-3枚区域淋巴结转移
p67 Phrase Metastases in ≥4 regional lymph nodes ≥4枚区域淋巴结转移
p68 Phrase The use of multiple pelvic fields 使用多盆腔野放疗
p69 Phrase New cases: 40,340 (rectal cancer only) ​新发病例数：40,340（仅直肠癌）
p70 Phrase MAC is the modified Astler-Coller classification MAC系统为改良Astler-Coller分期标准
p71 Phrase Metastasis in 1 regional lymph node 1枚区域淋巴结转移
p72 Phrase Palliative, endoscopic-placed stents to relieve obstruction 姑息性内镜下支架置入术缓解梗阻症状
p73 Phrase To detect new or metachronous malignancies 检测是否有新发肿瘤或异时性癌
p74 Phrase Metastases in 2–3 regional lymph nodes 2-3枚区域淋巴结转移
p75 Phrase Perforation or obstruction of the bowel 是否存在肠穿孔或肠梗阻
p76 Phrase Presence or absence of distant metastases 是否存在远处转移
p77 Phrase Table 2. Regional Lymph Nodes (N) 表2.区域淋巴结（N）
p78 Phrase Patients receiving panitumumab experienced improved OS 帕尼单抗组的OS优于对照组
p79 Phrase Stage IV and Recurrent Rectal Cancer IV期与复发性直肠癌
p80 Phrase Cellular Classification and Pathology of Rectal Cancer 直肠癌的细胞学分类和病理
p81 Phrase Resection of isolated pulmonary or ovarian metastases 孤立性肺转移灶或卵巢转移灶切除术
p82 Phrase Hyperplastic polyposis syndrome: BRAF and KRAS2 genes ​增生性息肉综合征：BRAF和KRAS2基因
p83 Phrase Adjuvant chemotherapy following chemoradiation therapy and surgery 放化疗和手术后的辅助化疗
p84 Phrase Adherence to or invasion of adjacent organs 粘连或浸润毗邻器官
p85 Phrase Capecitabine plus weekly oxaliplatin with radiation therapy 卡培他滨联合每周一次奥沙利铂和放疗
p86 Phrase To assess the efficacy of initial therapy 评估初步治疗的效果
p87 Phrase Deaths: 50,830 (colon and rectal cancers combined) 死亡病例数：50,830（合并结肠癌与直肠癌）
p88 Phrase Attenuated familial adenomatous polyposis (AFAP): APC gene 轻表型家族性腺瘤性息肉病（AFAP）：APC基因
p89 Phrase The Role of Oxaliplatin for Localized Disease 奥沙利铂对局限病变的作用
p90 Phrase Metastases in >1 organ/site or the peritoneum 远处转移分布于一个以上的器官/部位或腹膜转移
s1 Sentence The lead reviewers for Rectal Cancer Treatment are: 直肠癌治疗的首席审核人为：
s2 Sentence Personal history of colorectal cancer or colorectal adenomas ​结直肠癌或结直肠腺瘤病史
s3 Sentence Personal history of ovarian, endometrial, or breast cancer ​卵巢癌、子宫内膜癌或乳腺癌病史
s4 Sentence IVCI 5-FU plus weekly oxaliplatin with radiation therapy ​5-FU IVCI加每周一次奥沙利铂联合放疗
s5 Sentence Reprinted with permission from AJCC: Colon and rectum 经允许转载自AJCC：结肠与直肠
s6 Sentence Four to six months of 5-FU-based chemotherapy postoperatively 术后进行为期4-6个月的以5-FU为基础的化疗
s7 Sentence Intravenous continuous infusion (IVCI) 5-FU with radiation therapy 5FU静脉连续输液（IVCI）联合放疗
s8 Sentence Gastrointestinal stromal tumors can occur in the rectum ​胃肠道间质瘤亦可发生于结肠
s9 Sentence More common conditions with an increased risk include: 其他增加直肠癌风险的因素包括：
s10 Sentence National Surgical Adjuvant Breast and Bowel Project (NSABP) 美国乳腺与肠道外科辅助治疗研究项目（NSABP）
s11 Sentence To detect potentially curable recurrent or metastatic cancers 检测是否有潜在的可治愈性复发或转移癌
s12 Sentence Colorectal cancer affects men and women almost equally 男性与女性的结直肠癌发病率基本相当
s13 Sentence Each arm of the trial included 1,123 patients 每个治疗组各有1,123例患者入组
s14 Sentence (See Treatment Option Overview section for more information.) （更多信息请参见：治疗选择概述）
s15 Sentence The Addition of Targeted Therapy to Multiagent Chemotherapy 多药化疗方案中添加靶向治疗
s16 Sentence Tumor invades through the muscularis propria into pericolorectal tissues 肿瘤肿瘤穿透固有肌层到达直肠周围组织
s17 Sentence Positron emission tomography (PET) to image distant metastatic disease 使用正电子发射断层扫描（PET）评估远处转移情况
s18 Sentence L-cell, glucagon-like peptide and pancreatic polypeptide/peptide YY (PYY)-producing tumor 分泌胰高血糖素样多肽与胰腺多肽/YY肽（PYY）的L细胞瘤
s19 Sentence Longer-term outcomes including OS have not yet been reported 包括OS在内的长期指标评估目前还未报道
s20 Sentence Drug combinations described in this section include the following: 本章节将提及的化疗药物联合使用方案包括：
s21 Sentence First-degree family history of colorectal cancer or colorectal adenomas ​一级亲属中有结直肠癌或结直肠腺瘤病史
s22 Sentence Marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type 粘膜相关淋巴组织型边缘区B细胞淋巴瘤
s23 Sentence Expert-reviewed information summary about the treatment of rectal cancer 关于直肠癌治疗的专家审核信息总结
s24 Sentence Unusual Cancers of Childhood Treatment (colorectal cancer in children) 儿童罕见肿瘤的治疗（儿童结直肠癌）
s25 Sentence Juvenile polyposis syndrome: SMAD4 / DPC4 and BMPR1A genes 幼年性息肉病综合征：SMAD4/DPC4和BMPR1A基因
s26 Sentence Tumor penetrates to the surface of the visceral peritoneum 肿瘤穿透脏层腹膜表面
s27 Sentence Complete colonoscopy to rule out cancers elsewhere in the bowel 全面结肠镜检查，排除肠道其他部位肿瘤
s28 Sentence The primary objective of this study is locoregional disease control 本研究的主要目的为局部肿瘤控制
s29 Sentence The staging system does not apply to the following histologies: 此分期系统不适用于下列组织学类型：
s30 Sentence Pan-body computed tomography (CT) scan to rule out metastatic disease 行全身计算机断层扫描（CT），排除转移性疾病
s31 Sentence The 1,630 patients were randomly assigned to three treatment groups: 研究将1,630例患者随机分为三个治疗组
s32 Sentence Carcinoma in situ : intraepithelial or invasion of lamina propria 局限于上皮内或侵犯粘膜固有层
s33 Sentence With metastatic disease, adenopathy, hepatomegaly, or pulmonary signs may be present 存在转移性疾病时可有淋巴结肿大、肝大或肺部体征
s34 Sentence Worldwide, colorectal cancer is the third most common form of cancer 结直肠癌（CRC）位列全球最常见恶性肿瘤第三位
s35 Sentence The same classification is used for both clinical and pathologic staging 临床与病理分期采用相同分类
s36 Sentence The initial clinical evaluation and staging procedures may include the following: 初始临床评估和分期方法包括：
s37 Sentence The reasons for lack of benefit in adding cetuximab are unclear 增添西妥昔单抗治疗后患者无获益的原因尚不明确
s38 Sentence The use of three dimensional or other advanced radiation planning techniques 使用三维或其他高级放疗计划技术
s39 Sentence Tumor directly invades or is adherent to other organs or structures 肿瘤直接侵犯或粘连于其他器官或组织结构
s40 Sentence Melanoma (See the PDQ summary on Melanoma Treatment for more information.) 黑色素瘤（更多信息参见PDQ总结：黑色素瘤的治疗​）
s41 Sentence cTNM is the clinical classification, and pTNM is the pathologic classification cTNM为临床分类，pTNM为病理分类
s42 Sentence Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome: mismatch repair (MMR) genes 遗传性非息肉病性结直肠癌（HNPCC）或Lynch综合征：错配修复（MMR）基因
s43 Sentence Other PDQ summaries containing information related to rectal cancer include the following: 其他与直肠癌相关的信息请参加下列PDQ总结：
s44 Sentence Lymphoma(See the PDQ summary on Adult Hodgkin Lymphoma Treatment for more information.) 淋巴瘤（更多信息参见PDQ总结：成人霍奇金淋巴瘤的治疗​）
s45 Sentence Resection of locally recurrent rectal cancer may be curative in selected patients 某些局部复发性直肠癌患者行手术切除可达到治愈效果
s46 Sentence Patients with tumors that are pathologically T1 may not need postoperative therapy 病理分期为T1期的肿瘤不常规进行术后治疗
s47 Sentence Similar to colon cancer, symptoms of rectal cancer may include the following: ​直肠癌的症状和结肠癌类似，包括：
s48 Sentence CRM or depth of penetration of the tumor through the bowel wall CRM，或肿瘤对肠壁的浸润深度
s49 Sentence Very selected patients with T2 tumors may be candidates for local excision 极少数T2期患者也可以进行局部切除
s50 Sentence Hepatic metastasis may be considered to be resectable based on the following: 在以下情况中肝转移可考虑行切除术：
s51 Sentence Metastasis confined to 1organ or site (e.g., liver, lung, ovary, nonregional node) 远处转移局限于单个器官或部位（如肝脏、肺、卵巢、非区域性淋巴结）
s52 Sentence The AJCC has designated staging by TNM classification to define rectal cancer AJCC使用TNM系统进行直肠癌分期
s53 Sentence Because of its superficial nature, surgical and other procedures may be limited 这一特性使手术和其他治疗手段受到一定程度的限制
s54 Sentence However, there are no data in rectal cancer to support this consideration 但是目前没有相关的直肠癌数据支持这一建议
s55 Sentence Palliative surgical resection with either low-anterior resection (LAR) or abdominoperineal resection (APR) 姑息性切除术包括低位前切除术（LAR）或经腹会阴联合切除术（APR）
s56 Sentence Laboratory examination may reveal iron-deficiency anemia and electrolyte and liver function abnormalities 实验室检查可发现缺铁性贫血、电解质异常或肝功能异常
s57 Sentence All patients received a TME and an additional four cycles of 5-FU-based chemotherapy 所有患者均接受TME与另外4程以5-FU为基础的术后化疗
s58 Sentence The primary goals of postoperative surveillance programs for rectal cancer are the following: 直肠癌术后监测计划的主要目的包括：
s59 Sentence These results have now been updated with a median follow-up of 11 years 目前，经过11年中位随访期，该研究对结果进行了更新
s60 Sentence (Refer to the PDQ summary on Gastrointestinal Stromal Tumors Treatment for more information.) （更多信息请参见PDQ总结胃肠道间质瘤的治疗）
s61 Sentence Physical examination may reveal a palpable mass and bright blood in the rectum 体格检查可能发现可触及的直肠肿块、退指可见鲜血
s62 Sentence Adenocarcinomas account for the vast majority of rectal tumors in the United States 美国直肠癌大多为腺癌
s63 Sentence Tumor that is adherent to other organs or structures, grossly, is classified cT4b 大体观察见粘连于其他器官或结构上的肿瘤，则分期为cT4b
s64 Sentence Of greater concern is the potential for late morbidity following rectal cancer treatment 而值得重视的是直肠癌治疗后的潜在晚期并发症
s65 Sentence In this case, further assessment by MRI or flexible ERUS may be considered 此时需要考虑进一步使用MRI或软式ERUS
s66 Sentence Presence or absence of nodal involvement and the number of positive lymph nodes 是否存在淋巴结受累，阳性淋巴结的数量
s67 Sentence Patients with rectal cancer who would be candidates for resection of liver metastases 将行肝转移灶切除的直肠癌患者
s68 Sentence Subsequently, several studies attempted to determine the optimal way to deliver adjuvant 5-FU 此后数项研究尝试寻找5-FU的最佳给药方法
s69 Sentence Carcinoid tumors (See the PDQ summary on Gastrointestinal Carcinoid Tumors Treatment for more information.) 类癌（更多信息参见PDQ总结：消化道类癌的治疗​）
s70 Sentence Omission of radiation therapy seems premature, since locoregional recurrence remains a clinically relevant problem 目前，局部区域性复发仍然是临床上的重要问题，舍弃放疗似乎仍言之尚早
s71 Sentence The AIO Colorectal Study Group randomly assigned 474 patients to either FUFOX or CAPOX AIO结直肠研究组研究将474例患者随机分为FUFOX组和CAPOX组
s72 Sentence Sarcoma (See the PDQ summary on Adult Soft Tissue Sarcoma Treatment for more information.) 肉瘤（更多信息参见PDQ总结：成人软组织肉瘤的治疗​）
s73 Sentence Currently, there are seven active and approved drugs for patients with metastatic colorectal cancer: 目前有7种已获批准的活性药物可以行单药治疗或者联合其他药物治疗：
s74 Sentence Better surgical techniques and advances in preoperative imaging have improved patient selection for resection 随着手术、术前影像学技术的进步，对可行手术切除的患者的筛选也更合理
s75 Sentence Oxaliplatin has significant activity when combined with 5-FU-LV in patients with metastatic colorectal cancer 奥沙利铂与5-FU-亚叶酸联用时对患有转移性结直肠癌的患者有显著疗效
s76 Sentence These results are still preliminary, and additional information with regard to OS is anticipated 以上为初步研究结果，和OS相关的更多信息还有待进一步研究
s77 Sentence Total mesorectal excision (TME) with either low anterior resection (LAR) or abdominoperineal resection (APR) 遵守全直肠系膜切除术（TME）原则的直肠低位前切除术（LAR）或经腹会阴联合直肠癌切除术（APR）
s78 Sentence All patients received a TME and an additional four cycles of 5-FU–based chemotherapy postoperatively 所有患者均接受TME和以5-FU为基础的4程术后化疗
s79 Sentence Estimated new cases and deaths from rectal cancer in the United States in 2013: 据估计，2013年美国直肠癌新发病例数和死亡病例数约为：
s80 Sentence In addition, a new tumor-metastasis staging strategy for node-positive rectal cancer has been proposed 关于淋巴结阳性的直肠癌患者，亦有研究者提出了一种新的转移分期方法
s81 Sentence These patients have 5-year survival rates similar to patients who initially had resectable disease 这些患者的5年生存率与初始病灶可切除的患者相似
s82 Sentence The study randomly assigned 430 patients and was closed early due to poor accrual 此研究中430例患者被随机分配至不同的化疗组，后因患者入组速度过慢，研究提前结束
s83 Sentence Wide surgical resection with abdominoperineal resection (APR) for lesions too distal to permit LAR 若病变位于低位直肠，无法行LAR，可行经腹会阴联合直肠癌切除术（APR），实施大范围手术切除
s84 Sentence Because of its localized nature at presentation, stage I has a high cure rate I期直肠癌诊断时病变局限，治愈率较高
s85 Sentence Preoperative chemoradiation with fluorouracil (5-FU) for patients with clinically staged T3 or T4 rectal adenocarcinoma 临床分级为T3或T4期的直肠腺癌患者可接受术前氟尿嘧啶（5-FU）放化疗
s86 Sentence Chemotherapy consisted of 5-FU/LV with 45 Gy in 25 fractions with a 5.4 Gy boost 化疗方案包括氟尿嘧啶和亚叶酸，放疗剂量为45Gy，分25次照射，外加5.4Gy强化照射
s87 Sentence Locally recurrent rectal cancer may be resectable, particularly if an inadequate prior operation was performed 局部复发性直肠癌是有切除机会的，尤其在前次手术切除不彻底的情况下
s88 Sentence Among KRAS wild-type patients, the HR favored the FOLFIRI/cetuximab group (HR, 0.68; 95% CI, 0.50–0.94) 在野生型KRAS基因型肿瘤患者中，HR数据提示FOLFIRI/西妥昔单抗更优（HR，0.68；95%CI，0.50-0.94）
s89 Sentence There were no significant differences detected for 10-year cumulative incidence of distant metastases or DFS 两治疗组的10年累积远处转移率或无病生存率（DFS）没有显著差异
s90 Sentence However, only disease stage (tumor, nodal, and distant) has been validated in multi-institutional prospective studies 但一些多中心前瞻性研究只证实了疾病分期（原发肿瘤、局部淋巴结和远处转移）与预后相关
s91 Sentence In addition, the MRC sought to evaluate the effect of intermittent chemotherapy versus continuous chemotherapy MRC也试图评估间歇化疗与连续化疗的有效性是否不同
s92 Sentence Total mesorectal excision (TME) with autonomic nerve preservation (ANP) techniques via low anterior resection (LAR) 直肠低位前切除术（LAR）由保留自主神经（ANP）的全直肠系膜切除术（TME）组成
s93 Sentence Differences include surgical technique, the use of radiation therapy, and the method of chemotherapy administration 差异体现在手术方式、放疗和化疗方案方面
s94 Sentence The primary treatment for patients with rectal cancer is surgical resection of the primary tumor 手术切除原发肿瘤是直肠癌的主要治疗手段
s95 Sentence The prognosis of patients with rectal cancer is related to several factors, including the following: 直肠癌患者的预后与下述因素相关：
s96 Sentence A review of the use of this tumor marker for rectal cancer suggests the following: 对这一肿瘤标记物的使用进行文献综述，显示如下结果：
s97 Sentence There was no difference in the number of patients receiving an APR in each arm 两组接受经腹会阴联合直肠癌切除术（APR）的病例数没有差异
s98 Sentence Digital-rectal examination and/or rectovaginal exam and rigid proctoscopy to determine if sphincter-saving surgery is possible 肛门指检和（或）直肠阴道检查，硬式前列腺镜检查可以帮助评估是否实施保肛手术
s99 Sentence Complete pathologic response rates of 10% to 25% may be achieved with preoperative chemoradiation therapy 术前放化疗的病理完全缓解率可达10%-25%
s100 Sentence The 10-year OS is equivalent in both arms (10-year OS, 59.6% vs 59.9%, P = .85) 两个治疗组的10年总生存率（OS）相同（10年OS分别为59.6%和59.9%，P=0.85）
s101 Sentence Local transanal or other resection with or without perioperative external-beam radiation therapy (EBRT) plus fluorouracil (5-FU) 伴或不伴术前外照射（ERBT）联合氟尿嘧啶（5-FU）的局部经肛或其他方式切除术
s102 Sentence Improved surgical techniques and advances in preoperative imaging have allowed for better patient selection for resection 随着外科技术、术前影像学的进步，可切除的患者的筛选也更为准确
s103 Sentence Tumor deposit(s) in the subserosa, mesentery, or nonperitonealized pericolic or perirectal tissues without regional nodal metastases 浆膜下、肠系膜、无腹膜覆盖结肠/直肠周围组织内有肿瘤种植，无区域淋巴结转移
s104 Sentence The World Health Organization (WHO) classification of tumors of the colon and rectum include the following: 世界卫生组织（WHO）结肠和直肠肿瘤分类包括：
s105 Sentence Many academic oncologists recommend that FOLFOX be considered the standard for adjuvant chemotherapy in rectal cancer 许多肿瘤学家推荐患者使用FOLFOX化疗方案作为标准的直肠癌辅助化疗方案
s106 Sentence Levamisole (150 mg/day) was administered in 3-day cycles every 14 days before and after radiation therapy 并在放疗前后进行左旋咪唑给药，150mg/天，每14天为一疗程，每程用药3天
s107 Sentence The majority of genetically defined cases involve hMSH2 on chromosome 2p, and hMLH1 on chromosome 3p 大多数有遗传背景的病例与hMSH2（位于染色体2p）和hMLH1（位于染色体3p）基因相关
s108 Sentence OS was not significantly different between the groups (HR, 0.83; 95% CI, 0.67–1.02; P = .072) 两组OS无显著差异（HR，0.83，95%CI，0.67-1.02；P=0.072）
s109 Sentence There was no difference in the number of patients receiving an abdominoperineal resection in each arm 两组接受经腹会阴联合直肠癌切除术（APR）的病例数没有差异
s110 Sentence (Refer to the PDQ summaries on Colorectal Cancer Screening and Colorectal Cancer Prevention for more information.) （更多信息请参见PDQ总结：结直肠癌的筛查和结直肠癌的预防）
s111 Sentence Bladder distention during radiation therapy to exclude as much small bowel as possible from the fields 放疗期尽量充盈膀胱，使小肠远离放射野
s112 Sentence Treatment of patients with recurrent or advanced colorectal cancer depends on the location of the disease 复发性或晚期结直肠癌患者的治疗选择需考虑疾病部位
s113 Sentence Improved radiation planning and techniques may minimize these acute and late treatment-related complications. These techniques include: 优化放疗方案与技术可能会减少放疗相关急性和晚期并发症的发生，这些技术包括：
s114 Sentence The presence of hydronephrosis associated with recurrence appears to be a contraindication to surgery with curative intent 与复发相关的肾盂积水是根治性手术禁忌证之一
s115 Sentence Longer follow-up will be necessary to determine the effect on the primary endpoint of the study, DFS 本研究的主要终点为DFS，不同的治疗方案对于DFS的影响有待进一步随访研究证实
s116 Sentence Rare tumors, including carcinoid tumors, lymphomas, and neuroendocrine tumors, account for less than 3% of colorectal tumors 类癌、淋巴瘤、神经内分泌肿瘤等罕见肿瘤在结直肠癌中不足3%
s117 Sentence Full-thickness rectal resection by the transanal or transcoccygeal route for large lesions not amenable to local excision 对于范围较大、无法行局部切除的病变，通过经肛或经骶尾部入路入行全层直肠切除
s118 Sentence Transanal local excision (LE) and transanal endoscopic microsurgery (TEM) for select clinically staged T1/T2 N0 rectal cancers 对某些临床分期为T1/T2N0期的直肠癌行选择性经肛门局部切除术（LE）和经肛门内镜显微手术（TEM）
s119 Sentence Although liver recurrence was decreased, median or 4-year survival was not significantly different between the patient groups 两组患者的肝转移复发率均有减少，但其生存时间中位数和4年生存率并无显著差异
s120 Sentence The upper limits of CIs for HRs in both analyses were greater than the predefined noninferiority boundary 两项分析显示，HR置信区间上限均大于既定的非劣效性边界
s121 Sentence Chemotherapy consisted of fluorouracil and leucovorin with 45 Gy in 25 fractions with a 5.4 Gy boost 化疗方案包括氟尿嘧啶和亚叶酸，放疗剂量为45Gy，分25次照射，外加5.4Gy强化照射
s122 Sentence Large, well-designed, prospective, multi-institutional, randomized studies may be required to establish an evidence-based consensus for follow-up evaluation 关于应如何选择患者的随访评估方案，需要设计精良的大型前瞻性多中心随机研究以达成循证共识
s123 Sentence Updated statistics with estimated new cases and deaths for 2013 (cited American Cancer Society as reference 1) 更新了2013年新发病例数与死亡病例数估计值的统计数据​（引用美国癌症协会参考文献1）
s124 Sentence While intermittent chemotherapy was not deemed noninferior, there appeared to be clinically insignificant differences in patient outcomes 尽管未证实间歇化疗的非劣效性，但其对患者结局并无显著影响
s125 Sentence Resection of liver metastases in selected patients (5-year cure rate with resection of solitary metastases exceeds 20%) 一些患者可行肝转移灶切除术（孤立性转移灶的5年治愈率超过20%）
s126 Sentence A statistically significant survival benefit has been demonstrated for more intensive follow-up protocols in two clinical trials 两项临床研究中发现强化随访组的生存率有统计学显著获益
s127 Sentence The comparisons between arms A and B and arms A and C were analyzed and published separately 研究分别分析并发表了A组和B组、A组和C组的差异
s128 Sentence Patients with previously untreated metastatic colorectal cancer were randomly assigned to either IFL or IFL plus bevacizumab 初治转移性结直肠癌患者随机分组，分别接受IFL方案或IFL联合贝伐单抗方案治疗
s129 Sentence FOLFOX has become the standard arm in the latest Intergroup study evaluating adjuvant chemotherapy in rectal cancer 在目前对比不同辅助化疗的组间临床研究中，FOLFOX方案通常作为标准治疗组
s130 Sentence Postoperative chemoradiation for patients with stage II or III rectal cancer who did not receive preoperative chemoradiation 对于未接受术前放化疗的II期或III期直肠癌患者，可施行术后放化疗
s131 Sentence The results of the now completed NSABP C-07 study confirmed and extended the results of the MOSAIC trial 目前已经结束的NSABPC-07研究证实并进一步扩展了MOSAIC临床试验的结果
s132 Sentence Measurement of the serum carcinoembryonic antigen (CEA) level for prognostic assessment and the determination of response to therapy 测量血清癌胚抗原（CEA）水平，评估预后和治疗效果
s133 Sentence There are three potential options for surgical resection in stage I rectal cancer: local excision, LAR, and APR 目前对于I期直肠癌有三种可选的手术方式：局部切除术、LAR和APR
s134 Sentence Although the primary endpoint was OS, a protocol-planned analysis of response to preoperative therapy has been preliminarily reported 研究主要临床终点为OS，初步研究汇报了符合方案集的术前治疗缓解率结果
s135 Sentence There was no difference between the continuously treated patients (arm A) and the intermittently treated patients (arm C) 连续化疗组（A组）和间歇化疗组（C组）的有效性无差异
s136 Sentence There were no significant differences detected for a 10-year cumulative incidence of distant metastases or disease-free survival (DFS) 两组10年累积远处转移率和无病生存率（DFS）没有显著差异
s137 Sentence This trial has initiated discussion in the oncologic community as to the proper role of postoperative radiation therapy 这一临床试验在肿瘤学界引起了大范围的讨论，分析术后放疗在治疗中的具体作用
s138 Sentence The STAR-01 trial similarly investigated the role of oxaliplatin combined with 5-FU chemoradiation for locally advanced rectal cancer 类似地，STAR-01临床研究也分析了奥沙利铂联合5-FU放化疗对于局部晚期直肠癌的作用
s139 Sentence The 10-year overall survival (OS) is equivalent in both arms (10-year OS, 59.6% vs 59.9%, P = .85) 两个治疗组的10年总生存率（OS）相同（10年OS分别为59.6%和59.9%，P=0.85）
s140 Sentence OS was not significantly different. Patients with mutant KRAS tumors experienced no benefit from the addition of panitumumab 两组OS无显著差异，帕尼单抗未使KRAS基因突变型肿瘤患者得到额外获益
s141 Sentence Patients who have a complete pathologic response (ypT0, N0, cM0) may be similar to stage group 0 or I 完全病理缓解（ypT0, N0, cM0）的患者与分期0期或I期相似
s142 Sentence TME was performed in 98% of both groups at a median interval of 6 weeks after chemoradiation was completed 放化疗完成后，两个治疗组98%的患者接受了TME分期评估，评估间隔时间中位数为6周
s143 Sentence The rate of pCR was equivalent at 16% in both arms (OR 0.98; 95% CI, 0.66–1.44, P = .904) 两个治疗组的pCR率均为16%（OR：0.98；95%CI：0.66-1.44；P=0.904）
s144 Sentence Although the intended sample size was 900 patients, the study closed early because of poor accrual, with 267 patients 研究计划的样本量为900例患者，但因招募速度过慢而提前结束，截止结束时共招募了267例患者
s145 Sentence Routine, periodic studies following patients treated for rectal cancer may lead to earlier identification and management of recurrent disease 对直肠癌患者的常规、定期检查可以早期发现和处理复发性疾病
s146 Sentence Several studies show increased local toxic effects with hepatic infusional therapy, including liver function abnormalities and fatal biliary sclerosis 一些研究指出，肝脏灌注治疗的局部毒性更高，可导致肝功能异常和致死性胆管硬化
s147 Sentence The 10-year overall survival (OS) is equivalent in both arms (10-year OS, 59.6% vs 59.9%, respectively P = .85) 两个治疗组的10年总生存率（OS）相同（10年OS分别为59.6%和59.9%，P=0.85）
s148 Sentence Nevertheless, these data suggest that FOLFOX4 may be a therapeutic option for patients with resected stage III colon cancer 然而这些数据显示，FOLFOX4方案可以作为术后III期结肠癌患者的治疗选择
s149 Sentence The distance of the tumor from the anal sphincter musculature has implications for the ability to perform sphincter-sparing surgery 肿瘤距离肛门括约肌的距离决定了是否可行肛门括约肌保留术
s150 Sentence Measurement of CEA, a serum glycoprotein, is frequently used in the management and follow-up of patients with rectal cancer CEA是一种血清糖蛋白，常用于直肠癌患者的治疗和随访评估
s151 Sentence A subset analysis evaluating efficacy vis a vis KRAS status was done in patients enrolled on the Crystal Study 对Crystal研究中部分患者进行亚组分析，评估了KRAS基因型和有效性之间的关系
s152 Sentence The TTP was 8.9 months versus 9.5 months ( P = .153) and met the prespecified range for noninferiority 两组TTP分别为8.9个月和9.5个月（P=0.153），位于既定的非劣性范围内
s153 Sentence Presence or absence of high-risk pathologic features, including positive surgical margins, lymphovascular invasion, perineural invasion, and poorly differentiated histology 是否存在高危病理学特征，包括手术切缘阳性、脉管瘤栓、神经浸润和组织学分化较差等
s154 Sentence Of note, data on anal sphincter and sexual function were not reported, and toxicity was physician determined, not patient reported 值得注意的是，本研究未报道肛门括约肌和性功能相关的数据，毒性反应系医生记录，而非患者报告
s155 Sentence Serum CEA testing is not a valuable screening tool for rectal cancer because of its low sensitivity and low specificity 由于血清CEA测定的敏感性低、特异性低，其对于直肠癌筛查的价值不高
s156 Sentence TME via abdominoperineal resection (APR) for patients who are not candidates for sphincter-preserving operations, leaving patients with a permanent end-colostomy 对于无法保留肛门括约肌的患者，行经腹会阴联合直肠癌切除术（APR）伴全直肠系膜切除术（TME），保留永久性结肠造口
s157 Sentence Among all racial groups in the United States, African Americans have the highest sporadic colorectal cancer incidence and mortality rates 美国的所有种族人群中，非裔美国人的散发结直肠癌发病率和死亡率均居首位
s158 Sentence Patients who received CAPIRI had the highest (grade 3 or higher) rates of nausea, vomiting, diarrhea, dehydration, and hand-foot syndrome CAPIRI组患者中最高级（3级或3级以上）恶心、呕吐、腹泻、脱水和手足综合征的发生率最高
s159 Sentence The effect of bevacizumab on OS is likely to be less than what was seen in the original Hurwitz study 贝伐单抗对于OS的影响可能小于原先在Hurwitz研究中所观察到的效果
s160 Sentence The median TTP for FOLFOX4 versus 5-FU/LV was 4.6 months versus 2.7 months (stratified log-rank test, 2-sided P < .001) FOLFOX4和LV5FU2治疗组患者的TTP中位数分别为4.6个月和2.7个月（分层秩和检验，双边P<0.001）
s161 Sentence The use of combination intra-arterial chemotherapy with hepatic radiation therapy, especially employing focal radiation of metastatic lesions, is under evaluation 一些研究目前正在评估肝动脉内化疗加肝放疗，尤其是转移瘤的局部放疗效果
s162 Sentence Data from multiple studies have demonstrated a correlation between rates of pCR and endpoints including distant metastasis-free survival, DFS, and OS 多项临床研究数据显示，pCR率和无远处转移生存、DFS和OS等临床终点相关
s163 Sentence The hazard ratio was 0.80 (95% confidence interval [CI], 0.69–0.93), a 20% risk reduction in favor of FLOX ( P <.004) 危险比为0.80（95%置信区间[CI]：0.69-0.93），FLOX治疗组的风险下降了20%（P<0.004）
s164 Sentence Stage I tumors extend beneath the mucosa into the submucosa (T1) or into, but not through, the bowel muscle wall (T2) I期直肠癌侵袭超过粘膜层，浸润粘膜下层（T1期）或浸润（但不穿透）肠道肌层（T2期）
s165 Sentence Median survival in the combined therapy arm was 72.2 months versus 59.3 months in the monotherapy arm ( P = .21) 联合治疗组中位生存时间为72.2个月，而单方案治疗组中位生存时间为59.3个月（P=0.21）
s166 Sentence The NSABP R-03 similarly compared preoperative versus postoperative chemoradiotherapy for patients with clinically staged T3 or T4 or node-positive rectal cancer 类似地，NSABP R-03临床研究也对比了临床分期为T3、T4期或淋巴结阳性的患者接受术前放化疗或术后放化疗的效果
s167 Sentence Radiofrequency ablation has emerged as a safe technique (2% major morbidity and <1% mortality rate) that may provide long-term tumor control 射频消融术是一种安全的治疗手段（严重并发症发生率2%，死亡率小于1%），可能实现长期控制肿瘤的效果
s168 Sentence Excepting obstructive symptoms, the symptoms of rectal cancer neither necessarily correlate with the stage of disease nor signify a particular diagnosis 除了梗阻性症状，直肠癌的所有症状均和疾病的分期无关，亦无诊断特性
s169 Sentence For patients with locally recurrent and/or liver-only and/or lung-only metastatic disease, surgical resection, if feasible, is the only potentially curative treatment 对于局部复发和（或）仅有肝转移和（或）仅有肺转移灶的患者，如可手术切除，则手术切除是唯一的可能达到治愈的治疗
s170 Sentence Customized patient molds (belly boards) to exclude as much small bowel as possible from the fields and immobilize patients during treatment ​个体化定制模具（腹板），尽量使小肠远离放射野，并且在放疗过程中固定患者
s171 Sentence The 5-FU schedules in this study differed between the two arms, which may have contributed to the difference in outcomes noted 不排除上述结果与研究中的5-FU方案在两个治疗组的剂量差异相关
s172 Sentence A follow-up randomized trial from GITSG demonstrated that semustine does not produce an additive survival benefit to radiation therapy and 5-FU 此后GITSG进行的随机临床研究的随访结果显示，在放疗和5-FU化疗的基础上，司莫司汀并不增加患者生存获益
s173 Sentence Benefits of neoadjuvant chemoradiation include tumor regression, downstaging and improvement in resectability, and a higher rate of sphincter preservation and local control 新辅助放化疗的益处包括：缩小肿瘤体积、降期、增加可切除性、提高保肛率和局部控制率等
s174 Sentence On the basis of this study, cetuximab was approved for use in patients with metastatic colorectal cancer refractory to 5-FU and irinotecan 基于此项研究，西妥昔单抗获准治疗5-FU和伊立替康化疗后的仍难治的转移性结直肠癌患者
s175 Sentence Despite the preliminary nature of this study, the FDA approved panitumumab for use in patients with metastatic colorectal cancer refractory to chemotherapy 根据该研究的初步结果，FDA已批准帕尼单抗用于化疗难治性转移性结直肠癌患者
s176 Sentence The Crystal Study ( EMR 62202-013 [NCT00154102]) randomly assigned 1,198 patients with stage IV colorectal cancer to FOLFIRI with or without cetuximab Crystal研究（EMR62202-013）招募了1,198例IV期结直肠癌患者，随机分组为FOLFIRI联合西妥昔单抗方案治疗，或者仅接受FOLFIRI方案治疗
s177 Sentence Patients who undergo aggressive surgical procedures for rectal cancer can have chronic symptoms, particularly if there is impairment of the anal sphincter 接受直肠癌积极外科治疗的患者，尤其是未保留肛门括约肌的患者可能存在一些长期症状
s178 Sentence The 3- and 4-year DFS rates were 71.8% and 67% for the Roswell Park regimen and 76.1% and 73.2% for FLOX, respectively RoswellPark方案治疗组的3年与4年DFS分别为71.8%和67%，而FLOX方案治疗组的3年和4年DFS分别为76.1%和73.2%
s179 Sentence Therefore, there is no current role for off-trial use of concurrent oxaliplatin and radiation in the treatment of patients with rectal cancer 因此对于直肠癌的患者，非临床研究的治疗中并不推荐同时使用奥沙利铂和放疗
s180 Sentence Retrospective studies have demonstrated that the number of lymph nodes examined in colon and rectal surgery may be associated with therapeutic outcome 回顾性研究显示，结直肠癌手术清扫淋巴结数量和治疗结局相关
s181 Sentence For patients who have progressed on irinotecan-containing regimens, a randomized phase II study was performed of either cetuximab or irinotecan and cetuximab 一项II期随机临床研究对比西妥昔单抗或者伊立替康联合西妥昔单抗对接受含伊立替康化疗方案治疗后仍进展的患者的有效性
s182 Sentence Patients with hepatic metastases that are deemed unresectable will occasionally become candidates for resection if they have a good response to chemotherapy 初始不可切除性肝转移灶的患者如果有对化疗有良好反应，偶可行切除术
s183 Sentence The NSABP R-03 trial similarly compared preoperative with postoperative chemoradiation therapy for patients with clinical T3 or T4 or node-positive rectal cancer 类似地，NSABPR-03​临床研究也对比了临床分期为T3、T4期或淋巴结阳性的患者接受术前放化疗或术后放化疗的效果
s184 Sentence After bevacizumab was approved, the BICC-C trial was amended and an additional 117 patients were randomly assigned to receive FOLFIRI/bevacizumab or mIFL/bevacizumab 贝伐单抗获准使用后，BICC-C临床研究对研究方案进行了修正，新招募的117例患者被随机分组，接受FOLFIRI/贝伐单抗方案或mIFL/贝伐单抗方案治疗
s185 Sentence However, if no tumor is present in the adhesion, microscopically, the classification should be pT1–4a depending on the anatomical depth of wall invasion 若镜下未发现粘连处存在肿瘤，分期应根据其对肠壁的解剖学浸润深度改为pT1-4a
s186 Sentence These studies demonstrated an increase in both disease-free survival (DFS) interval and OS when radiation therapy was combined with chemotherapy after surgical resection 这些研究显示，术后放疗结合化疗有助于改善无病生存时间（DFS）和OS
s187 Sentence Treatment decisions should be made with reference to the TNM classification system, rather than the older Dukes or the Modified Astler-Coller classification schema 应当参考肿瘤的TNM分期系统决定治疗方案，老版的Dukes或改良Astler-Coller分类方法现已不用
s188 Sentence Subsequent studies have attempted to increase the survival benefit by improving radiation sensitization and by identifying the optimal chemotherapeutic agents and delivery systems 后续的一些临床研究试图通过优化化疗药物和给药途径来增加放疗敏感性，以此提高患者的生存获益
s189 Sentence A Cochrane review highlights the risks of increased surgical morbidity as well as late rectal and sexual function in association with adjuvant therapy Cochrane综述强调了手术并发症风险增高的问题和术后晚期直肠功能、性功能障碍与辅助放疗的关系
s190 Sentence Similarly, a phase III trial randomly assigned patients who progressed on irinotecan and 5-FU/LV to bolus and infusional 5-FU/LV, single-agent oxaliplatin, or FOLFOX4 类似地，一项III期临床试验招募了曾接受伊立替康联合5-FU-亚叶酸治疗并升级为5-FU静脉推注与输液联合亚叶酸（LV5FU2）、奥沙利铂单药治疗或FOLFOX4方案的患者
s191 Sentence The low incidence of local relapse following meticulous mesorectal excision has led some investigators to question the routine use of adjuvant radiation therapy 直肠系膜切除术后局部复发率较低，一些研究者因此质疑是否需要常规使用辅助放疗
s192 Sentence Intraoperative radiation therapy in patients who received previous external-beam radiation may improve local control in patients with locally recurrent disease, with acceptable morbidity 曾接受外照射的局部复发患者行术中放疗可能增加局部控制率，并发症尚在可接受范围内
s193 Sentence Among those randomly assigned patients, 27% were deemed ineligible at the time of surgery, leaving only 75 patients evaluable for recurrence and survival 这些随机分组的患者中，27%的患者在术前被评估为不适合进行手术，故仅余75名患者可进行复发率和生存率评估
s194 Sentence Again, an increase in grades 3 to 4 treatment-related acute toxicity was noted with the addition of oxaliplatin (24% vs 8%, P <.001) 奥沙利铂治疗组中3级和4级毒性反应发生率较高（分别为24%和8%，P<0.001）
s195 Sentence The median TTP for patients receiving cetuximab was 1.5 months compared to median TTP of 4.2 months for patients receiving irinotecan and cetuximab 接受西妥昔单抗治疗的患者中位TTP为1.5个月，接受伊立替康联合西妥昔单抗治疗的患者中位TTP则为4.2个月
s196 Sentence Median PFS was 7.3 months (95% CI, 6.3 months–8.0 months) for panitumumab-FOLFOX4 and 8.8 months (95% CI, 7.7 months–9.4 months) for FOLFOX4 alone 帕尼单抗/FOLOFX4组的中位PFS为7.3个月（95%CI，6.3-8.0个月），仅接受FOLFOX4组的中位PFS则为8.8个月（95%CI，7.7-9.4个月）
s197 Sentence Median PFS was 5.9 months (95% CI, 5.5 months–6.7 months) for panitumumab-FOLFIRI and 3.9 months (95% CI, 3.7 months–5.3 months) for FOLFIRI alone 帕尼单抗/FOLFIRI组中位PFS为5.9个月（95%CI，5.5-6.7个月）而单用用FOLFIRI组的中位PFS则为3.9个月（95%CI，3.7-5.3个月）
s198 Sentence Second-line chemotherapy with irinotecan in patients treated with 5-FU-leucovorin as first-line therapy demonstrated improved OS when compared to either infusional 5-FU or supportive care 对于以5-FU-亚叶酸作为一线治疗的患者，伊立替康二线化疗与对5-FU输液或支持性治疗相比，可使患者的OS有所改善
s199 Sentence Stage 0 rectal cancer is the most superficial of all rectal lesions and is limited to the mucosa without invasion of the lamina propria 在所有直肠病变中，0期直肠癌病变范围最为表浅，局限于粘膜层，未浸润固有层
s200 Sentence A large number of studies have evaluated various other clinical, pathologic, and molecular parameters; as yet, none has been validated in multi-institutional prospective trials 大量研究评估了许多其他临床、病理和组织分子与预后的关系，但目前缺乏多中心前瞻性临床试验的证实
s201 Sentence Patients treated with FOLFOX4 experienced more frequent toxic effects, consisting mainly of neutropenia (41% >grade 3) and reversible peripheral sensory neuropathy (12.4% >grade 3) 接受FOLFOX4方案治疗的患者中毒性反应发生率高于另一组，主要为中性粒细胞减少症（41%，大于3级）和可逆的周围感觉性神经病变（12.4%，大于3级）
s202 Sentence Local excision should only be applied to very select patients with T2 tumors, as there is a higher risk of local and systemic failure 局部切除术仅适用于部分T2期肿瘤患者，并且局部和全身治疗失败的风险均较高
s203 Sentence Based on these two studies, bevacizumab can reasonably be added to either FOLFIRI or FOLFOX for patients undergoing first-line treatment of metastatic colorectal cancer 基于以上研究结果，有理由将贝伐单抗加入FOLFIRI或FOLFOX化疗方案，作为治疗转移性结直肠癌的一线方案
s204 Sentence Median OS was 21.3 months for patients receiving bevacizumab and 19.9 months for patients receiving placebo (HR, 0.89; 97.5% CI, 0.76–1.03, P = .077) 贝伐单抗组患者中位OS为21.3个月，安慰剂组患者中位OS则为19.9个月（HR为0.89，97.5%CI为0.76-1.03，P=0.077）
s205 Sentence The median PFS was 9.4 months in the group receiving cetuximab and 10.7 months in the group not receiving cetuximab ( P = .01) 接受西妥昔单抗治疗的患者中位PFS为9.4个月，而不含西妥昔单抗组患者的中位PFS则为10.7个月（P=0.01）
s206 Sentence However, in general, for locally advanced rectal cancers for which radical resection is indicated, TME with ANP techniques via LAR is preferable to APR 对于可根治的局部进展期直肠癌，采用ANP和TME技术的LAR优于APR
s207 Sentence Hepatic intra-arterial chemotherapy with floxuridine for liver metastasis has produced higher overall response rates but no consistent improvement in survival when compared with systemic chemotherapy 肝动脉内氟脲苷化疗可提高肝转移患者的总体缓解率，但与全身化疗相比，动脉内化疗并未获得相似的生存改善
s208 Sentence Radiofrequency ablation and cryosurgical ablation remain options for patients with tumors that cannot be resected and for patients who are not candidates for liver resection 肿瘤不可切除或禁忌肝切除的患者可以选择接受射频消融或冷冻消融术
s209 Sentence In a phase III trial that has not yet been reported, patients with chemotherapy-refractory colorectal cancer were randomly assigned to panitumumab or best supportive care 一项尚未发表的III期临床试验将化疗无效的难治性结直肠癌患者随机分入帕尼单抗组或最佳支持治疗组
s210 Sentence Local recurrence rates were significantly reduced in the radiation therapy plus TME arm (2.4%) as compared with the TME only arm (8.2%, P < .001) 放疗组的局部复发率（2.4%）较TME手术组（8.2%）有显著降低（P<0.001）
s211 Sentence Adenocarcinomas account for the vast majority of rectal cancers. Other histologic types of colorectal cancer account for an estimated 2% to 5% of colorectal tumors 直肠肿瘤多数为腺癌，其他结直肠癌组织学分型约占结直肠肿瘤总数的2%-5%
s212 Sentence Despite the lack of direct data, in standard practice, bevacizumab was added to FOLFOX as a standard first-line regimen based on the results of NCCTG-N9741 尽管缺乏直接数据，基于NCCTG-N9741临床研究结果，目前在实践中已将贝伐单抗加入FOLFOX方案作为标准一线治疗方案
s213 Sentence Endorectal ultrasound (ERUS) with a rigid probe or a flexible scope for stenotic lesions to determine the depth of penetration and identify locoregional nodal metastases 硬式或软式直肠腔内超声（ERUS）评估梗阻性病灶的浸润深度，检查是否有局部淋巴结转移
s214 Sentence Staging studies may be required if recurrence or progression of disease is suspected; MRI may be particularly helpful in determining sacral involvement in local recurrence 若怀疑疾病进展或复发，则需要进一步分期评估；MRI对评估局部复发时的骶尾部受累很有帮助
s215 Sentence Patients with poor histologic features or positive margins after local excision should consider LAR or APR and postoperative treatment as dictated by full surgical staging 组织学分化较差或在局部切除术后边缘阳性的患者可以考虑接受LAR或APR，并根据全面的外科分期接受相应的术后治疗
s216 Sentence Because of the increased risk of local recurrence and a poorer overall prognosis, the management of rectal cancer varies somewhat from that of colon cancer 由于直肠癌局部复发风险高，总体预后差，其治疗与结肠癌存在一定不同
s217 Sentence Visualization of the small bowel through oral contrast during treatment planning so that when possible, the small bowel can be excluded from the radiation field 治疗计划期间口服对比剂以显示小肠位置，尽可能使小肠远离放射野
s218 Sentence The ideal candidate for local excision has a T1 tumor with well-to-moderate differentiation that occupies less than one-third of the circumference of the bowel wall 比较理想的情况是T1期、中低分化、且环腔不超过1/3周的肿瘤
s219 Sentence Investigators from the Eastern Cooperative Oncology Group (ECOG) randomly assigned patients who had progressed on 5-FU/LV and irinotecan to either FOLFOX or FOLFOX and bevacizumab 在东部肿瘤协作组开展的研究中，接受5-FU-亚叶酸和伊立替康化疗后出现疾病进展的患者被随机分组接受FOLFOX或FOLFOX联合贝伐单抗治疗
s220 Sentence (Refer to the PDQ summary on Genetics of Colorectal Cancer for more information.) The hereditary colorectal cancer syndromes and some genes that are involved include: （更多信息请参见PDQ总结：结直肠癌的遗传学​一节）遗传性结直肠癌综合征和相关的基因包括：
s221 Sentence Preoperative chemoradiation therapy has become the standard of care for patients with clinically staged T3–T4 or node-positive disease, based on the results of several studies 根据几项研究的结果，对于临床T3-T4期或淋巴结阳性的患者，术前放化疗已经成为标准治疗
s222 Sentence Guidelines for surveillance after initial treatment with curative intent for colorectal cancer vary between leading U.S. and European societies, and optimal surveillance strategies remain uncertain 美国和欧洲肿瘤协会制定的治疗指南关于初步治愈性治疗后的结直肠癌患者的监测建议不同，目前无最佳监测方案
s223 Sentence A meta-analysis that combined these two trials with four others was reported to show a statistically significant improvement in survival for patients who were intensively followed 对这两项研究和另外四项研究行荟萃分析，结果显示接受强化随访的患者生存率有统计学显著改善
s224 Sentence Although the primary endpoint was sphincter preservation, late toxicity was not statistically significantly different between the two treatment approaches (7% long course vs 10% short course) 尽管本研究的主要终点为括约肌保留率，但两组的晚期毒性反应发生率无显著差异（长期治疗组7%，短期治疗组10%）
s225 Sentence For patients with mutant KRAS tumors, there was worse PFS with the addition of panitumumab (HR, 1.29; 95% CI, 1.04–1.62; P = .02, stratified log-rank test) 对KRAS基因突变型的肿瘤患者，帕尼单抗对PFS有不良影响（HR，1.29，95%CI，1.04-1.62；分层秩和检验P=0.02）
s226 Sentence There was a significant interaction for KRAS mutation status and treatment for tumor response ( P = .03) but not for PFS ( P = .07) KRAS基因突变状态和肿瘤对治疗的反应有显著的互相作用（P=0.03），但与PFS之间的关系则不显著（P=0.07）
s227 Sentence Wide surgical resection and anastomosis when an adequate low-anterior resection (LAR) can be performed with sufficient distal rectum to allow a conventional anastomosis or coloanal anastomosis 当远端直肠长度足够进行直肠低位前切除术（LAR），并允许进行传统吻合或结直肠吻合时，行大范围的手术切除和肠吻合
s228 Sentence In 2000, colorectal cancer accounted for 9.4% of the world's new cancers, with 945,000 cases diagnosed, and 7.9% of the world's cancer deaths, with 492,000 deaths 2000年，世界范围内新发癌症中有9.4%为结直肠癌，诊断病例数为945,000例，死亡病例数为492,000例，占全球所有癌症死亡病例数的7.9%
s229 Sentence The 5-year cumulative incidence of local relapse was 6% for patients assigned to preoperative chemoradiation and 13% in the postoperative treatment group ( P = .006) 术前放化疗组的患者中有27%出现了3级或4级急性毒性反应，而术后放化疗组相应比例则为40%（P=0.01）
s230 Sentence In a post hoc analysis, patients with KRAS wild-type tumors experienced a statistically significant PFS advantage (HR, 0.73; 95% CI, 0.59–0.90; P = .004, stratified log-rank) 事后分析显示，KRAS基因野生型肿瘤患者的PFS有统计学优势（HR，0.73；95%CI，0.59-0.90；分层秩和检验中P=0.004）
s231 Sentence For patients with advanced cancers of the mid- to upper rectum, LAR followed by the creation of a colorectal anastomosis may be the treatment of choice 中上段进展期直肠癌患者首选LAR及肠吻合术
s232 Sentence Tis includes cancer cells confined within the glandular basement membrane (intraepithelial) or mucosal lamina propria (intramucosal) with no extension through the muscularis mucosae into the submucosa Tis包括肿瘤细胞局限于腺体基底膜（上皮内）或粘膜固有层（粘膜内），未穿透粘膜肌层抵达粘膜下层
s233 Sentence Recent progress in adjuvant postoperative treatment regimens relates to the integration of systemic therapy with radiation therapy, as well as redefining the techniques for both modalities 近年来，术后辅助治疗方案的发展倾向于放疗和系统治疗的整合，对两者的技术也有了新的定义
s234 Sentence The addition of cetuximab was associated with an improved PFS (HR, 0.85; 95% CI, 0.72–0.99, P = .048 by a stratified log rank test), but not OS 添加西妥昔单抗后PFS有所改善（HR，0.85；95%CI，0.72-0.99,分层秩和检验P=0.048），但OS无改善
s235 Sentence Preoperative chemoradiation therapy has become the standard of care for patients with clinically staged T3 or T4 or node-positive disease, based on the results of several studies 基于数项研究的结果，临床分期为T3、T4期或淋巴结阳性的患者目前应常规行术前放化疗
s236 Sentence Although a higher percentage of patients achieved a pCR in the oxaliplatin-treated group (19.2% vs 13.9%), the difference did not reach statistical significance ( P = .09) 尽管含奥沙利铂的治疗组中达到pCR的患者比例更高（分别为19.2%和13.9%），但这一差异并没有统计学差异（P=0.09）
s237 Sentence Using current surgical techniques, including TME, it may be possible to identify subsets of patients whose chance of pelvic failure is low enough to omit postoperative radiation 使用包括TME在内的各项外科治疗后，某些患者术后盆腔治疗失败概率小，可以不接受术后放疗
s238 Sentence Additionally, there was no difference noted in the rate of pathologically positive lymph nodes, tumor infiltration beyond the muscularis propria, or the rate of circumferential margin positivity 两组病理学上阳性淋巴结数、超过固有肌层的肿瘤浸润或周围边缘阳性率均无差异
s239 Sentence The accuracy in determining metastatic nodal involvement by ERUS is approximately 70% to 75% compared with 55% to 65% for CT and 60% to 70% for MRI ERUS对转移淋巴结的评估准确性约为70%至75%，CT为55%至65%，MRI则为60%至70%
s240 Sentence Because of an increased tendency for first failure in locoregional sites only, the impact of perioperative radiation therapy is greater in rectal cancer than in colon cancer 因首次手术失败多仅为局部复发，故围手术期放疗对直肠癌的效果大于结肠癌
s241 Sentence However, a local-control benefit persists among patients treated with preoperative chemoradiation compared with postoperative chemoradiation (10-year cumulative of local relapse, 7.1% vs 10.1%, respectively; P = .048) 但术前放化疗组患者的局部病灶控制获益仍高于术后放化疗组的患者（10年累积局部复发率分别为7.1%和10.1%，P=0.048）
s242 Sentence Subset analyses suggest that the use of capecitabine was associated with an inferior outcome, and the use of second-line therapy was less in patients treated with cetuximab 亚组分析显示卡培他滨治疗与预后较差相关，并且该研究中接受西妥昔单抗治疗的患者很少接受二线治疗
s243 Sentence No DFS, OS, or locoregional failure (LRF) difference was detected (across all arms: 3-year DFS, 67% to 69%; 3-year OS, 81% to 83%; LRF, 4.6% to 8%) （三组的数据范围：3年DFS：67%-69%；3年OS：81%-83%；LRF：4.6%-8%）
s244 Sentence Arm 2 received continuous infusion 5-FU before (300 mg/m2 /day for 42 days), after (300 mg/m2 /day for 56 days), and during (225 mg/m2 /day) radiation therapy 第2组放疗前、后和期间接受5-FU连续输液，放疗前剂量300mg/m2/天（共42天），放疗后剂量300mg/m2/天（共56天），放疗期间剂量（225mg/m2/天）
s245 Sentence The Bolus, Infusional, or Capecitabine with Camptosar-Celecoxib (BICC-C) trial evaluated several different irinotecan-based regimen in patients with previously untreated metastatic colorectal cancer: FOLFIRI, mIFL, and capecitabine/irinotecan (CAPIRI) 静脉推注、输液或卡培他滨联合盐酸伊立替康-塞来昔布（BICC-C）临床试验评估了几项不同的基于伊立替康的化疗方案，用于治疗初治的转移性结直肠癌患者，评估的方案包括FOLFIRI、mIFL和卡培他滨/伊立替康方案（CAPIRI）
s246 Sentence Controversy regarding the efficacy of regional chemotherapy was the basis of a large multicenter phase III trial ( CALGB-9481) (NCT00002716) of hepatic arterial infusion versus systemic chemotherapy 由于局部化疗有效性存在争议，一项大型多中心III期临床试验（CALGB-9481）（NCT00002716）对比了肝动脉灌注治疗与全身化疗的作用
s247 Sentence Prior to the advent of multiagent chemotherapy, two randomized studies demonstrated that capecitabine was associated with equivalent efficacy when compared with the Mayo Clinic regimen of 5-FU/LV 再出现多药化疗之前，有2项随机研究发现卡培他滨与梅奥诊所方案5-FU/LV有效性相同
s248 Sentence However, similar to the other studies, patients treated with oxaliplatin had significantly higher rates of grade 3 and 4 acute toxicity (15.4% vs 6.6%, P < .001) 和其他研究结果类似，奥沙利铂组3级和4级毒性反应有显著增高（分别为15.4%和6.6%，P<0.001）
s249 Sentence Arm 2 received continuous infusion 5-FU before (300 mg/m2 /day for 42 days), after (300 mg/m2 / day for 56 days), and during (225 mg/m2 /day) radiation therapy 组2在放疗前（ 300mg/m2/天，共42天）、放疗后（ 300mg/m2/天，共56天）和放疗中（ 225mg/m2/天）接受5-FU连续输液
s250 Sentence Similar to the German Rectal Study, there was no significant difference seen in OS between treatment arms (74.5% vs 65.6%, P = 065 for preoperative vs. postoperative chemoradiation.) 两个治疗组的OS没有显著差异，这一结果和德国直肠癌研究相似（术前放化疗和术后放化疗组的OS分别为74.5%和65.6%，P=0.065）
s251 Sentence In another study ( NCT00339183 ), patients with metastatic colorectal cancer who had already received a fluoropyrimidine regimen were randomly assigned to either FOLFIRI or FOLFIRI plus panitumumab 另一项研究（NCT00339183 ）将氟嘧啶化疗后的转移性结直肠癌患者随机分组，接受FOLFIRI或FOLFIRI-帕尼单抗化疗
s252 Sentence The XELOX regimen (capecitabine plus oxaliplatin): Oral capecitabine (1,000 mg/m2 ) twice a day for 14 days plus oxaliplatin (130 mg/m2 ) on day 1 every 3 weeks XELOX化疗方案：每日口服卡培他滨（1,000mg/m2）2次，连续14天，同时第1天奥沙利铂输液（130mg/m2），每三周重复一次
s253 Sentence However, a local control benefit persists among patients treated with preoperative chemoradiation compared with postoperative chemoradiation (10-year cumulative of local relapse, respectively; 7.1% vs 10.1%, P = .048) 但术前放化疗组患者的局部病灶控制获益仍高于术后放化疗组的患者（10年累积局部复发率分别为7.1%和10.1%，P=0.048）
s254 Sentence Retrospective studies, such as Intergroup trial INT-0089 [EST-2288], have demonstrated that the number of lymph nodes examined in colon and rectal surgery may be associated with patient outcome 包括组间试验INT-0089[EST-2288]在内的回顾性研究认为，结直肠癌手术淋巴结清扫数量与患者预后相关
s255 Sentence For patients with T1 and T2 tumors, no randomized trials are available to compare local excision with or without postoperative chemoradiation to wide surgical resection (LAR and APR) 对于T1或T2期患者，目前尚无随机临床试验对比有（或无）术后放化疗的局部切除术与大范围切除术（LAR与APR）的有效性差异
s256 Sentence Polypectomy alone for cure may be used in certain instances in which polyps with invasive cancer can be completely resected with clear margins and have favorable histologic features 对于能够彻底切除、切缘干净且组织学特征良好的恶变息肉，可以采用息肉切除术
s257 Sentence With a median follow-up of 8.4 years, preoperative chemoradiation was found to confer a significant improvement in 5-year DFS (64.7% vs 53.4% for postoperative patients, P = .011) 中位随访8.4年，结果显示，术前放化疗可以显著改善5年DFS（64.7%，术后放化疗组为53.4%，P=0.011）
s258 Sentence Local excision of clinical T1 tumors is an acceptable surgical technique for appropriately selected patients. For all but T1 tumors, a mesorectal excision is the treatment of choice 对于某些临床T1期肿瘤，可行局部切除术，而其他分期的肿瘤则需要进行直肠系膜切除术
s259 Sentence Multiple phase II studies of preoperative chemoradiation suggested that administering radiation therapy prior to surgery improved the toxicity profile of chemoradiation and enhanced the possibility of sphincter-sparing surgery 多项关于术前放化疗的II期临床研究显示，在术前放疗有助于改善放化疗的毒性谱，增加手术保留肛门括约肌的可能性
s260 Sentence Similar to the German Rectal Study, there was no significant difference seen in OS between treatment arms (74.5% vs 65.6%, P = .065 for preoperative vs. postoperative chemoradiation.) 两个治疗组的OS没有显著差异，这一结果和德国直肠癌研究相似（术前放化疗和术后放化疗组的OS分别为74.5%和65.6%，P=0.065）
s261 Sentence Similar to the German Rectal Study, there was no significant difference seen in OS between treatment arms (74.5% vs 65.6%, P = .065 for preoperative vs. postoperative chemoradiation) 两个治疗组的OS没有显著差异，这一结果和德国直肠癌研究相似（术前放化疗和术后放化疗组的OS分别为74.5%和65.6%，P=0.065）
s262 Sentence Accurate staging provides crucial information about the location and size of the primary tumor in the rectum, and, if present, the size, number, and location of any metastases 准确的分期可提供的关键信息包括直肠原发肿瘤的位置、大小和转移灶的大小、数量和位置等
s263 Sentence Median PFS was 9.6 months (95% CI, 9.2 months–11.1 months) for patients who received panitumumab-FOLFOX4 and 8.0 months (95% CI, 7.5 months–9.3 months) for patients who received FOLFOX4 帕尼单抗/FOLOFX4组的中位PFS为9.6个月（95%CI，9.2-11.1个月），仅接受FOLFOX4组的中位PFS则为8.0个月（95%CI，7.5-9.3个月）
s264 Sentence Patients with limited pulmonary metastases and patients with both pulmonary and hepatic metastases may also be considered for surgical resection, with 5-year survival possible in highly selected patients 对某些精心选择的患者，即便合并局限肺转移，或是肝肺转移，如果条件允许也可以考虑手术，甚至获得5年生存的机会
s265 Sentence However, a local control benefit persists among patients treated with preoperative chemoradiation compared with postoperative chemoradiation (10-year cumulative of local relapse, respectively: 7.1% vs 10.1%, P = .048) 但术前放化疗组患者的局部病灶控制获益仍高于术后放化疗组的患者（10年累积局部复发率分别为7.1%和10.1%，P=0.048）
s266 Sentence Patients with limited pulmonary metastasis, and patients with both pulmonary and hepatic metastasis, may also be considered for surgical resection, with 5-year survival possible in highly selected patients 某些局限性肺转移、或同时肝转移者也可考虑手术切除，甚至实现长期生存
s267 Sentence (Refer to the PDQ summary on Nausea and Vomiting and refer to the Diarrhea section in the PDQ summary on Gastrointestinal Complications for information on diarrhea and dehydration.) （参考PDQ总结恶心与呕吐，关于腹泻与脱水的更多信息请参考PDQ总结胃肠道并发症中腹泻章节）
s268 Sentence It is difficult to separate epidemiological considerations of rectal cancer from those of colon cancer because epidemiological studies often consider colon and rectal cancer (i.e., colorectal cancer) together ​流行病学研究多同时研究结肠癌和直肠癌（即结直肠癌），故很难分别描述结肠癌和直肠癌的流行病学特征
s269 Sentence An analysis of patients treated with postoperative chemotherapy and radiation therapy suggests that these patients may have more chronic bowel dysfunction compared with those who undergo surgical resection alone 对接受术后化疗与放疗的患者进行分析，结果发现这些患者比仅接受手术的患者罹患慢性肠道功能障碍的可能性更高
s270 Sentence Retrospective studies have demonstrated that some patients with pathological T3, N0 disease treated with no further therapy after surgery have a very low risk of local and systemic recurrence 回顾性研究显示，病理分期为T3，N0期的患者在术后不接受任何治疗的情况下，其局部与全身复发的风险仍较低
s271 Sentence A second trial preoperatively randomly assigned patients with one to three potentially resectable colorectal hepatic metastases to either no further therapy or postoperative hepatic arterial floxuridine plus systemic 5-FU 另一项临床研究招募了有1-3处潜在可切除结肠癌肝转移患者，术前所有患者分配至两组，一组在术后不接受其他治疗，另一组术后接受肝动脉氟尿苷联合全身5-FU化疗
s272 Sentence These high-risk groups account for only 23% of all colorectal cancers. Limiting screening or early cancer detection to only these high-risk groups would miss the majority of colorectal cancers 这些高危人群仅占所有结直肠癌病例的23%，因此，仅仅对这些人群进行筛查和早期癌症检测将漏诊大部分结直肠癌病例
s273 Sentence In affected families, 15% to 60% of family members are found to have mutations in hMSH2 or hMLH1 ; the mutation prevalence depends on features of the family history 患病家系中，15%-60%的家庭成员中有hMSH2或hMLH1的突变，突变发生率和家族史特点有关
s274 Sentence The use of induction chemoradiation for previously nonirradiated patients with locally advanced (pelvic side-wall, sacral, and/or adjacent organ involvement) pelvic recurrence may increase resectability and allow for sphincter preservation 对于无放疗史的局部晚期（盆腔侧壁、骶骨和/或相邻器官受累）患者，诱导放化疗可能增加病灶切除、保留括约肌的机会
s275 Sentence No disease-free survival (DFS), OS, or locoregional failure (LRF) difference was detected (across all arms: 3-year DFS, 67% to 69%; 3-year OS, 81% to 83%; 3-year LRF, 4.6% to 8%) 三组的DFS、OS和局部失败率（LRF）未见差异（三个治疗组的数据范围：3年DFS：67%-69%；3年OS：81%-83%；LRF：4.6%-8%）
s276 Sentence In a meta-analysis of 84 studies, none of the three imaging modalities, including ERUS, CT, and MRI, were found to be significantly superior to the others in staging nodal status 对84项研究进行的一项荟萃分析指出，在转移淋巴结的评估中，ERUS、CT和MRI三种影像手段并未优于其他手段
s277 Sentence The bony constraints of the pelvis limit surgical access to the rectum, which results in a lesser likelihood of attaining widely negative margins and a higher risk of local recurrence 骨盆的骨性结构限制了直肠手术操作，导致阴性切缘可能性降低，局部复发可能性增加
s278 Sentence Similarly, there was no effect on PFS (8.6 months [IQR, 5.0–12.5] in the control group vs 8.6 months [IQR, 5.1–13.8] in the cetuximab group; HR, 0.96; 0.82–1.12, P = .60) 与之相似，PFS亦无差异（对照组中位PFS为8.6个月[IQR：5.0-12.5]，西妥昔单抗组的中位PFS为8.6个月[IQR：5.1-13.8]；HR，0.96；95%CI，0.82-1.12；P=0.60）
s279 Sentence The V and L classifications should be used to identify the presence or absence of vascular or lymphatic invasion, whereas the PN site-specific factor should be used for perineural invasion V和L分类用于标注是否有血管和淋巴浸润，PN部位特异性因子则用于描述神经侵犯
s280 Sentence Dukes B is a composite of better (T3, N0, M0) and worse (T4, N0, M0) prognostic groups, as is Dukes C (any T, N1, M0 and any T, N2, M0) Dukes B级包含了预后较好（T3, N0, M0）和预后较差（T4, N0, M0）组，Dukes C级亦然（任何T, N1, M0 与任何T, N2, M0 ）
s281 Sentence Ashkenazi Jews also have an increased risk for colorectal cancer related to a mutation in the APC gene (I1307K), which occurs in 6% to 7% of the Ashkenazi Jewish population 德系犹太人患APC基因（I1307K）突变的结直肠癌的风险较高，约占德系犹太人群的6%-7%
s282 Sentence There are currently no completed randomized controlled studies evaluating whether continued use of bevacizumab in the second line or third line after progressing on a first-line bevacizumab regimen is worthwhile 目前尚无已完成的随机对照研究评估如果一线贝伐单抗方案治疗后进展，在二线或三线化疗中是否继续使用贝伐单抗
s283 Sentence Accurate initial staging can influence therapy by helping to determine the type of surgical intervention and the choice of neoadjuvant therapy to maximize the likelihood of resection with clear margins 在病程初期，准确分期可以帮助决定手术方式和新辅助化疗方案，以尽可能实现切缘干净
s284 Sentence Individuals with certain known single-gene disorders are at an increased risk of developing rectal cancer. Single-gene disorders related to known syndromes account for about 10% to 15% of colorectal cancers 某些已知的单基因病患者罹患直肠癌的风险增高，相关的单基因病患者占结直肠癌病例的10%-15%左右
s285 Sentence The CAPOX regimen (capecitabine and oxaliplatin): Capecitabine (1,000 mg/m2 ) twice a day on days 1 through 14 plus oxaliplatin (70 mg/m2 ) on days 1 and 8 every 3 weeks CAPOX化疗方案（卡培他滨与奥沙利铂）：第1-14天卡培他滨（1,000mg/m2）输液，每天2次，并且每3周第1-8天奥沙利铂（70mg/m2）输液
s286 Sentence The acute side effects of pelvic radiation therapy for rectal cancer are mainly the result of gastrointestinal toxicity, are self-limiting, and usually resolve within 4 to 6 weeks of completing treatment 对于直肠癌盆腔放疗的急性副作用主要是胃肠道毒性导致，这些副作用大多为自限性，在治疗结束后的4-6周内消退
s287 Sentence Prior to the standard use of preoperative chemoradiation for stage II and III rectal cancer, several studies established the benefits of adjuvant combined-modality therapy for surgical stage II and III disease 对于II期和III期结肠癌患者，术前放化疗在成为标准治疗前经历了多项临床研究，以确认辅助联合治疗对于II期和III期患者的益处
s288 Sentence Replaced nodes should be counted separately as positive nodes in the N category, whereas discontinuous spread or venous invasion should be classified and counted in the site-specific factor category Tumor Deposits 被取代的淋巴结在N类分期标准中应被算作独立的阳性淋巴结，而不连续转移、静脉浸润应被归为肿瘤种植部位特异性因子并被计数
s289 Sentence Arm 1 received bolus 5-FU in two 5-day cycles before (500 mg/m2 /day) and after (450 mg/m2 /day) radiation therapy, with protracted venous infusion 5-FU (225 mg/m2 /day) during radiation therapy 第1组在放疗前后分别接受两个周期的5-FU推注，每周期5天，放疗前剂量500mg/m2/天，放疗后剂量450mg/m2/天，放疗过程中则接受5-FU连续静脉输液（225mg/m2/天）
s290 Sentence Approximately 15% to 25% of colorectal cancer patients will present with liver metastases at diagnosis, and another 25% to 50% will develop metachronous hepatic metastasis following resection of the primary tumor 约有15%到25%的结直肠癌患者在诊断时已有肝转移，另有25%-50%患者在原发肿瘤切除后发生异时性肝转移
s291 Sentence Based on the results of several studies, oxaliplatin does not appear to add any benefit in terms of primary tumor response, but it has been associated with increased acute treatment-related toxicity 根据数项研究结果，在治疗中加入奥沙利铂不增加原发肿瘤的治疗获益，反而增加急性治疗相关毒性事件的发生
s292 Sentence Additional studies are required to evaluate this treatment approach and to determine whether more effective systemic combination chemotherapy alone would provide similar results compared to hepatic intra-arterial therapy plus systemic treatment 此治疗方法的有效性需要进行更多临床研究评估，以对比单独使用更有效力的全身联合化疗的临床结局是否与肝动脉内化疗联合全身化疗类似
s293 Sentence For patients with hepatic metastasis considered to be resectable, a negative-margin resection has resulted in 5-year survival rates of 25% to 40% in mostly nonrandomized studies, such as the NCCTG-934653 trial 对于可切除性肝转移患者，多数非随机性临床研究（如NCCTG-934653 ）显示，术后切缘阴性者5年生存率可达25%至40%
s294 Sentence A Polish study randomly assigned 316 patients between preoperative long course chemoradiation (50.4 Gy in 28 daily fractions with 5-FU and LV) and short-course preoperative radiation therapy (25 Gy in 5 fractions) 一项波兰研究将316例患者随机分组，接受术前长期放化疗（50.4Gy，分28次，每日一次，联合5-FU和LV化疗）或短期放疗（25Gy，分5次）
s295 Sentence Patients treated with adjuvant radiation therapy appear to have increased chronic bowel dysfunction, anorectal sphincter dysfunction (if the sphincter was surgically preserved), and sexual dysfunction than those who undergo surgical resection alone 经过辅助放疗的患者发生慢性肠道功能障碍、肛门直肠括约肌功能障碍（若手术保留括约肌）和性功能障碍的几率高于单纯手术切除的患者
s296 Sentence The surgical approach to treatment varies according to the location, stage, and presence or absence of high-risk features (i.e., positive margins, lymphovascular invasion, perineural invasion, and poorly differentiated histology) and may include: 直肠癌的外科治疗手段各异，选择时应当考虑肿瘤的位置、分期、是否存在高危因素（即手术切缘阳性、淋巴血管浸润、神经浸润和组织学分化程度较差）等，手术方法包括：
s297 Sentence A major pooled analysis evaluating the impact of T and N stage and treatment on survival and relapse in patients with rectal cancer who are treated with adjuvant therapy has been published 一项大型汇总分析评估了T分期、N分期和治疗对新辅助治疗后直肠癌患者生存及复发的影响
s298 Sentence The approach to the management of rectal cancer should be multimodal and should involve a multidisciplinary team of cancer specialists with expertise in gastroenterology, medical oncology, surgical oncology, radiation oncology, and radiology 直肠癌的治疗需要多种模式联合治疗，以及多学科肿瘤专家的共同参与，如胃肠病学、肿瘤药物学、肿瘤外科学、肿瘤放射学和放射学的专业知识
s299 Sentence Median survival in the intent-to-treat population (n = 815 in both groups) was 15.8 months (IQR, 9.4–26.1) in arm A and 14.4 months (IQR, 8.0–24.7) in arm C (HR, 1.084; 80% CI, 1.008–1.165) 对意向治疗集（两组均为n=815）的分析显示，A组中位生存时间为15.8个月（IQR：9.4-26.1），C组中位生存时间为14.4个月（IQR：8.0-24.7）（HR，1.084；80%CI，1.008-1.165）
s300 Sentence IFL (or Saltz) regimen (irinotecan, 5-FU, and LV): Irinotecan (125 mg/m2 ), 5-FU (500 mg/m2 ) IV bolus, and LV (20 mg/m2 ) IV bolus administered weekly for 4 out of 6 weeks IFL（又名Saltz）化疗方案（伊立替康、5-FU和亚叶酸）：每周行伊立替康（125mg/m2）输液，静脉推注5-FU（500mg/m2）和亚叶酸（20mg/m2），共四周，每6周重复一次
s301 Sentence Although only a small proportion of patients with liver metastasis are candidates for surgical resection, advances in tumor ablation techniques and in both regional and systemic chemotherapy provide a number of treatment options 虽然只有小部分肝转移患者适合手术切除，但肿瘤消融、局部和全身化疗的发展提供了更多的治疗选择
s302 Sentence However, preoperative radiation therapy is associated with increased complications compared to surgery alone; some patients with cancers at a lower risk of local recurrence might be adequately treated with surgery and adjuvant chemotherapy 但是和单纯手术相比，术前放疗的并发症风险增加，手术联合辅助化疗已经足以治愈一些局部复发风险较低的直肠癌患者
s303 Sentence Patients with tumors that are T2 or greater have lymph node involvement about 20% of the time, and additional therapy should be considered, such as radiation and chemotherapy, or more standard surgical resection T2期或更高分期的肿瘤患者中约有20%存在淋巴结浸润，应考虑增加术后治疗，如放疗、化疗或更标准的手术切除
s304 Sentence The addition of radiation, while significantly reducing local recurrence at 5 years (8% for chemotherapy and radiation vs 13% for chemotherapy alone, P = .02), demonstrated no significant benefit in terms of survival 分析发现进行放疗可以显著降低5年局部复发率（放化疗组和化疗组5年局部复发率分别为8%和13%，P=0.02），但受试者生存率没有显著受益
s305 Sentence Moreover, the rate of grade 3 or 4 toxicity was significantly higher in the oxaliplatin-treated group (25% vs 11%, P < .001), and there was no difference in sphincter-sparing surgery (75% vs 78%) 并且奥沙利铂治疗组3级和4级毒性反应的发生率显著高于对照组（分别为25%和11%，P<0.001），两组接受保留肛门括约肌手术的患者比例无差异（分别为75%和78%）
s306 Sentence Oxaliplatin has also been shown to have radiosensitizing properties in preclinical models; and phase II studies combining this agent with fluoropyrimidine-based chemoradiation have reported pathologic complete response (pCR) rates ranging from 14% to 30% 临床前研究发现奥沙利铂有放射致敏性；联用奥沙利铂与含氟尿嘧啶放化疗的II期临床研究结果显示，病理完全缓解（pCR）率在14%至30%不等
s307 Sentence In a subset analysis, cetuximab-treated patients with tumors bearing a mutated KRAS gene had significantly decreased PFS compared with cetuximab-treated patients with wild type KRAS tumors (8.1 mo. vs 10.5 mo.; P = .04) 亚组分析显示，接受西妥昔单抗治疗后，携带KRAS突变基因的患者PFS显著低于KRAS野生型的患者（分别为8.1个月和10.5个月；P=0.04）
s308 Sentence In the tumor (T) staging of rectal carcinoma, several studies indicate that the accuracy of ERUS ranges from 80% to 95% compared with 65% to 75% for CT and 75% to 85% for MRI 对于直肠癌（T）分期，一些研究认为ERUS的准确性在80%至95%，CT为65%至75%，MRI则为75%至85%
s309 Sentence The median PFS was 7.1 months for the CAPOX arm and 8.0 months for the FUFOX arm (HR, 1.17; 95% CI, 0.96–1.43: P = .117), and the HR was in the prespecified equivalence range CAPOX组中位PFS为7.1个月，FUFOX组为8.0个月（HR，1.17；95%CI，0.96-1.43；P=0.117），且HR位于既定的等效性范围内
s310 Sentence Several trials have analyzed the activity and toxic effects of various 5-FU-leucovorin (5-FU/LV) regimens, using different doses and administration schedules, and showed essentially equivalent results with a median survival time in the 12-month range 一些临床试验分析了不同的5-FU-亚叶酸（5-FU/LV）治疗方案，对比了不同剂量和给药方案的的有效性与毒性，研究显示各项化疗方案疗效基本相当，各组患者的生存时间中位数均在12个月内
s311 Sentence The interpretation of the interaction of radiation therapy with prognostic factors, however, was challenging. Radiation appeared to improve survival among patients younger than 60 years, as well as among patients who received abdominoperineal resection 放疗对预后因素的具体影响难以分析，放疗似乎可以提高60岁以下患者以及经腹会阴直肠癌切除术患者的生存率
s312 Sentence For patients with local recurrence alone following an initial, attempted curative resection, aggressive local therapy with repeat LAR and coloanal anastomosis, APR, or posterior or total pelvic exenteration can lead to long-term disease-free survival 对于初次根治切除术后局部复发的患者，一些局部侵袭性扩大手术可能获得长期无病生存的治疗效果，如复LAR手术、结肠造瘘、APR、全盆或后盆腔脏器切除术
s313 Sentence In addition, multiple studies with multiagent chemotherapy have demonstrated that patients with metastatic disease isolated to the liver, which historically would be considered unresectable, can occasionally be made resectable after the administration of chemotherapy 并且多项多药联合化疗临床研究显示，一些在过去被诊断为无法行手术切除的独立肝转移病灶，如今在接受化疗后偶可转化为可切除病灶
s314 Sentence The patients who received FOLFIRI had a better PFS than the patients who received either mIFL (7.6 months vs 5.9 months, P = .004) or CAPIRI (7.6 months vs 5.8 months, P = .015) FOLFIRI化疗组患者的PFS优于mIFL组患者（分别为7.6个月和5.9个月，P=0.004），亦优于CAPIRI组患者（分别为7.6个月和5.8个月，P=0.015）
s315 Sentence Local excision should be restricted to tumors confined to the rectal wall and that do not, on rectal ultrasound or magnetic resonance imaging, involve the full thickness of the rectum (i.e., not a T3 tumor) 局部切除术仅适用于病变局限于肠壁，且直肠超声或MRI影像中肿瘤未浸润直肠全层（即非T3期肿瘤）
s316 Sentence In addition to determining the intent of rectal cancer surgery (i.e., curative or palliative), it is important to consider therapeutic issues related to the maintenance or restoration of normal anal sphincter, genitourinary, and sexual functions 直肠癌手术除了要明确治疗目的（根治还是姑息），还要考虑肛门括约肌、泌尿功能和性功能的维持和保护等治疗问题
s317 Sentence Following publication of the results of these trials, experts at a National Cancer Institute-sponsored Consensus Development Conference in 1990 concluded that postoperative combined-modality treatment is recommended for patients with stage II and III rectal carcinoma 这些结果发布后，1990年美国国家癌症研究所主办的共识发展会议指出，对于II期和III期直肠癌患者，推荐术后接受联合放化疗
s318 Sentence On subset analysis, the 6-year OS in patients with stage III colon cancer was 72.9% in the patients receiving FOLFOX and 68.9% in the patients receiving 5-FU/LV (HR, 0.80; 95% CI, 0.65–0.97, P = .023) 亚组分析显示，接受FOLFOX4辅助化疗方案的III期结肠癌患者的6年OS为72.9%，而接受5-FU-亚叶酸的III期结肠癌患者的6年OS则为68.9%（HR，0.80；95%CI，0.65-0.97；P=0.023）
s319 Sentence Although the primary endpoint of PFS was not significantly different, patients receiving FOLFIRI/bevacizumab had a significantly better OS (28.0 months vs 19.2 months, P = .037; HR for death, 1.79; 95% CI 1.12 to 2.88) 尽管研究中两组的主要终点PFS无显著差异，但FOLFIRI/贝伐单抗组患者OS显著改善（分别为28.0月余19.2月，P=0.037；死亡HR，1.79；95%CI，1.12-2.88）
s320 Sentence Magnetic resonance imaging (MRI) of the abdomen and pelvis to determine the depth of penetration and the potential for achieving negative circumferential (radial) margins, as well as to identify locoregional nodal metastases and distant metastatic disease 腹腔和盆腔的磁共振成像（MRI）评估肿瘤浸润深度和实现环周（径向）切缘阴性的可能性，同时确认是否有局部淋巴结转移和远处转移
s321 Sentence The FUFOX regimen (fluorouracil, LV, and oxaliplatin): Oxaliplatin (50 mg/m2 ) plus LV (500 mg/m2 ) plus 5-FU (2,000 mg/m2 ) as a 22-hour continuous infusion on days 1, 8, 22, and 29 every 36 days FUFOX化疗方案：第1、8、22、29天使用奥沙利铂（50mg/m2）、亚叶酸（500mg/m2）和5-FU（2,000mg/m2），连续输液22小时，每36天重复一次
s322 Sentence Patients randomly assigned to FOLFOX and bevacizumab experienced a statistically significant improvement in PFS (7.43 months vs 4.7 months, HR, 0.61; P < .0001) and OS (12.9 months vs 10.8 months, HR, 0.75; P = .0011) 接受FOLFOX联合贝伐单抗治疗的患者PFS（分别为7.43个月和4.7个月，HR为0.61；P<0.0001）和OS（分别为12.9个月和10.8个月，HR为0.75；P=0.0011）均优于单纯接受FOLFOX治疗的患者
s323 Sentence An Eastern Cooperative Oncology Group trial ( ECOG-E5202 [NCI-2009-00562]) randomly assigned patients with stage II or III rectal cancer who have received preoperative or postoperative chemoradiation therapy to 6 months of FOLFOX with or without bevacizumab 例如如东部肿瘤合作组一项的临床研究（ECOG-E5202​[NCI-2009-00562]）中，II期和III期直肠癌患者被随机分配接受6个月含贝伐单抗和不含贝伐单抗的术前或术后FOLFOX放化疗
s324 Sentence For patients with KRAS wild-type tumors, a statistically significant improvement in PFS was observed in those who received panitumumab-FOLFOX4 compared with those who received only FOLFOX4 (HR, 0.80; 95% CI, 0.66–0.97; P = .02, stratified log-rank test) KRAS基因野生型肿瘤患者中，接受帕尼单抗/FOLFOX4的患者PFS优于仅接受FOLFOX4的患者（HR，0.80，95%CI，0.66-0.97；分层秩和检验P=0.02）
s325 Sentence The agents associated with the first successful combined-modality treatments were 5-FU and semustine. Semustine is not commercially available, and previous studies have associated this drug with the potential for increased risks of renal toxic effects and leukemia 首个成功的化疗药物组合为5-FU和司莫司汀，司莫司汀目前尚未上市，此前进行的相关研究认为司莫司汀可能增加肾毒性反应和白血病的发生
s326 Sentence In patients with rectal cancer, the circumferential resection margin (CRM) is an important pathological staging parameter. Measured in millimeters, it is defined as the retroperitoneal or peritoneal adventitial soft-tissue margin closest to the deepest penetration of tumor 对直肠癌患者来说，环周切缘（CRM）是重要的病理分期参数，测量单位为毫米，定义为腹膜后或者脏层腹膜距肿瘤最深浸润部位的最近距离
s327 Sentence Postoperative CEA testing should be restricted to patients who are potential candidates for further intervention, as follows: Patients with stage II or III rectal cancer (every 2 to 3 months for at least 2 years after diagnosis) 术后CEA测定仅限用于需要继续干预的患者，包括：II期或III期直肠癌患者（诊断后每2-3个月检测一次，至少2年）
s328 Sentence In primary rectal cancer, pelvic imaging helps determine the depth of tumor invasion, the distance from the sphincter complex, the potential for achieving negative circumferential (radial) margins, and the involvement of locoregional lymph nodes or adjacent organs 对于原发性直肠癌，盆腔影像学可以显示肿瘤侵犯的深度、距肛门括约肌的距离、环周（径向）切缘阴性的可能性和局部区域性淋巴结、周围器官的侵犯情况
s329 Sentence Although postoperative therapy for patients with stage II or III rectal cancer remains an acceptable option, neoadjuvant therapy for rectal cancer, using preoperative chemoradiation, is now the preferred option for patients with stage II and III disease II期或III期直肠癌患者可以接受术后治疗，但目前更倾向于使用术前新辅助放化疗
s330 Sentence In this trial, 1,401 patients were randomly assigned, and the median PFS was 9.4 months for patients receiving bevacizumab and 8.0 months for the patients receiving placebo (HR, 0.83; 97.5% confidence interval [CI], 0.72–0.95; P = .0023) 此项临床试验中，共1,401例患者被随机分配至不同治疗组，贝伐单抗组患者中位PFS为9.4个月，安慰剂组中位PFS则为8.0个月（HR为0.83，97.5%CI为0.72-0.95，P=0.0023）
s331 Sentence Preliminary results of the study, with 37 months of follow-up, demonstrated a significant improvement in DFS at 3 years (77.8% vs 72.9%; P = .01) in favor of FOLFOX4. When initially reported, there was no difference in OS 该研究37个月随访期的初步结果显示，FOLFOX4方案组的3年DFS相较对照组有显著改善（分别为77.8%和72.9%，P=0.01），但初步报告显示OS无差异
s332 Sentence Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II rectal cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria 现招募II期直肠癌​患者的美国临床试验请参见美国NCI癌症临床试验列表，可根据部位、药物、干预或其他标准进行筛选
s333 Sentence This recommendation takes into consideration that the number of lymph nodes examined is a reflection of both the aggressiveness of lymphovascular mesenteric dissection at the time of surgical resection and the pathologic identification of nodes in the specimen 这一建议认为，受检淋巴结数量既可以反映术中肠系膜淋巴血管的受累情况，也可以对病理标本中的检出淋巴结进行评估
s334 Sentence Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III rectal cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria 现招募III期直肠癌​患者的美国临床试验请参见美国NCI癌症临床试验列表，可根据部位、药物、干预或其他标准进行筛选
s335 Sentence Subsequently, in a randomized phase III study, patients with untreated, stage IV colorectal cancer were randomly assigned in a 2 × 2 factorial design to CAPOX versus FOLFOX4, then to bevacizumab versus placebo. PFS was the primary endpoint 后续的一项III期随机临床研究将初治的IV期结直肠癌患者随机分组，采用2×2因素设计，先接受CAPOX或FOLFOX4方案治疗，后接受贝伐单抗或安慰剂治疗，研究主要终点为PFS
s336 Sentence Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage 0 rectal cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria 现招募0期直肠癌​患者的美国临床试验请参见美国NCI癌症临床试验列表，可根据部位、药物、干预或其他标准进行筛选
s337 Sentence Lethal toxicity was less than 1%, with grade 3 to 4 hematologic toxicity in 55% and 49% of patients in the two bolus arms, respectively (i.e., arms 1 and 3), versus 4% of patients in the continuous-infusion arm 致命性毒性反应发生率低于1%，两个推注组（即第1组与第3组）中，3、4级血液毒性事件发生率分别为55%和49%，而连续输液组的这一事件发生率则仅为4%
s338 Sentence The FUOX regimen (fluorouracil plus oxaliplatin): Continuous infusion 5-FU (2,250 mg/m^2 ) during 48 hours on days 1, 8, 15, 22, 29 and 36 plus oxaliplatin (85 mg/m2 ) on days 1, 15, and 29 every 6 weeks FUOX化疗方案：第1、8、15、22、29和36天5-FU（2,250mg/m2）连续输液48小时，第1、15、29天奥沙利铂输液（85mg/m2），每6周重复一次
s339 Sentence Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I rectal cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria 现招募I期直肠癌​患者的美国临床试验请参见美国NCI癌症临床试验列表，可根据部位、药物、干预或其他标准进行筛选
s340 Sentence In addition, gene expression profiling has been reported to be useful in predicting the response of rectal adenocarcinomas to preoperative chemoradiation therapy and in determining the prognosis of stage II and III rectal cancer after neoadjuvant 5-fluorouracil-based chemoradiation therapy 并且有研究报道，基因表达谱可以用于预测直肠腺癌对于术前放化疗的反应，并且可以用于评估II期和III期直肠癌患者接受以5-氟尿嘧啶为基础的新辅助化疗的预后
s341 Sentence However, among the 194 patients with tumors that were determined by the surgeon before randomization to require an abdominoperineal excision, a statistically significant increase in sphincter preservation was achieved among patients who received preoperative chemoradiation ( P = .004) 但随机分组前由外科医生决定需行经腹会阴联合切除术的194例直肠癌患者中，术前放化疗组患者的肛门括约肌保留率高于术后放化疗组，有统计学显著性（P=0.004）
s342 Sentence The American Joint Committee on Cancer (AJCC) and a National Cancer Institute-sponsored panel recommended that at least 12 lymph nodes be examined in patients with colon and rectal cancer to confirm the absence of nodal involvement by the tumor 美国癌症联合委员会和美国国家癌症研究所赞助的研究小组基于回顾性研究数据，建议对患有结肠癌或者直肠癌的患者活检至少12枚淋巴结，以确认肿瘤未侵犯淋巴结
s343 Sentence Another study, ( INT-0144 [NCT00002551]), was a three-arm randomized trial designed to determine whether continuous-infusion 5-FU throughout the entire standard six-cycle course of adjuvant chemotherapy was more effective than continuous 5-FU only during pelvic radiation and included the following: 另一项随机临床试验（INT-0144​[NCT00002551]）中受试者分为3组，研究了连续6程标准辅助化疗中5-FU连续输液的效果是否优于仅在盆腔放疗期间进行5-FU连续输液，结果如下：
s344 Sentence However, a multi-institutional retrospective analysis demonstrated that 22% of patients thought to have clinically node-negative T3 disease by ultrasound or magnetic resonance imaging were found, at the time of resection, to have positive mesorectal lymph nodes even after chemoradiation 但是一项多中心回顾性分析指出，通过超声或核磁共振（MRI）诊断为临床淋巴结阴性、T3分期的患者，有22%的人会在手术时发现直肠系膜阳性淋巴结，即便放化疗后也是如此
s345 Sentence HNPCC, the result of defects in MMR genes (involving hMSH2 , hMLH1 , hPMS1 , hPMS2 , or hMSH6 ) represents the most common form of hereditary colorectal cancer, accounting for approximately 3% to 5% of all colorectal malignancies ​由MMR基因（包括hMSH2，hMLH1，hPMS1，hPMS2或hMSH6）缺陷引起的HNPCC是最常见的遗传性结直肠癌类型，约占所有结直肠癌的3%-5%
s346 Sentence For patients with hepatic metastasis considered to be resectable, a negative margin resection has been associated with 5-year survival rates of 25% to 40% in mostly nonrandomized studies (such as the North Central Cancer Treatment Group trial, NCCTG-934653 ) 对于肝转移灶可切除的患者，多数非随机研究（例如美国中北部癌症治疗组试验NCCTG-934653）发现切缘阴性患者的5年生存率为25%-40%
s347 Sentence The NSABP-R-04 trial randomly assigned 1,608 patients with clinically staged T3 or T4 or clinical node-positive adenocarcinoma within 12 cm of the anal verge in a 2 × 2 factorial design to one of the following four treatment groups: NSABP-R-04临床研究安排1,608例临床分期为T3、T4期或有阳性淋巴结的距肛缘300px内直肠癌患者以2×2随机分组设计接受以下四种治疗方案：
s348 Sentence The Medical Research Council (MRC) ( UKM-MRC-COIN-CR10 [NCT00182715] or COIN trial) sought to answer the question of whether adding cetuximab to combination chemotherapy with a fluoropyrimidine and oxaliplatin in first-line treatment for patients with first-line KRAS wild-type tumors was beneficial 医学研究委员会（MRC）（UKM-MRC-COIN-CR10[NCT00182715]或COIN临床试验）研究了以氟嘧啶和奥沙利铂联合化疗作为一线治疗时，增加西妥昔单抗是否能使KRAS基因野生型的肿瘤患者获益
s349 Sentence A satellite peritumoral nodule in the pericolorectal adipose tissue of a primary carcinoma without histologic evidence of residual lymph node in the nodule may represent discontinuous spread, venous invasion with extravascular spread (V1/2), or a totally replaced lymph node (N1/2) 结肠周围脂肪组织中如有瘤周卫星结节，且无残留淋巴结的组织学证据，可能为不连续转移、静脉浸润与血管外播散（V1/2）、或被完全取代的淋巴结（N1/2）
s350 Sentence However, among the 194 patients with tumors that were determined by the surgeon before randomization to require an abdominoperineal excision, a statistically significant increase in sphincter preservation was achieved among patients who received preoperative chemoradiation therapy ( P = .004) 但随机分组前由外科医生决定需行经腹会阴联合切除术的194例直肠癌患者中，术前放化疗组患者的肛门括约肌保留率高于术后放化疗组，有统计学显著性（P=0.004）
s351 Sentence Another study, INT-0144 ( NCT00002551 ), was a three-arm randomized trial designed to determine whether continuous-infusion 5-FU throughout the entire standard six-cycle course of adjuvant chemotherapy was more effective than continuous 5-FU only during pelvic radiation and included the following: 一项随机临床试验（INT-0144[NCT00002551​]）中受试者分为3组，研究了连续6程标准辅助化疗中5-FU连续输液的效果是否优于仅在盆腔放疗期间进行5-FU连续输液，结果如下：
s352 Sentence In the Panitumumab Randomized Trial in Combination With Chemotherapy for Metastatic Colorectal Cancer to Determine Efficacy ( PRIME [20050203 or NCT00364013]) study, 1,183 patients were randomly assigned to FOLFOX4 with or without panitumumab as first-line therapy for metastatic colorectal cancer 在帕尼单抗联合化疗治疗转移性结直肠癌的有效性评估随机试验（PRIME[20050203或NCT00364013]）中，1,183例转移性结直肠癌患者被随机分组，接受含帕尼单抗和不含帕尼单抗的FOLFOX4方案作为一线治疗
s353 Sentence Ongoing clinical trials comparing preoperative and postoperative adjuvant chemoradiation therapy should further clarify the impact of either approach on bowel function and other important quality-of-life issues (e.g., sphincter preservation) in addition to the more conventional endpoints of DFS and OS 对于目前进行的比较术前和术后放化疗有效性的临床研究，除了按传统方法将DFS和OS纳入研究终点外，应当注意进一步观察并比较各种治疗方案对于肠道功能以及其他生活质量相关事件的影响（如保留肛门括约肌等）
s354 Sentence The median PFS (intention-to-treat analysis) was 8.0 months in the pooled CAPOX-containing arms versus 8.5 months in the FOLFOX4-containing arms (HR, 1.04; 97.5% CI, 0.93–1.16), with the upper limit of the 97.5% CI being below the predefined noninferiority margin of 1.23 含CAPOX患者组的汇总数据显示中位PFS（意向治疗集）为8.0个月，而含FOLFOX4患者组的汇总数据中位PSF为8.5个月（HR，1.04，97.5%CI，0.93-1.16），97.5%CI的上限值低于既定的非劣效性边界值1.23
s355 Sentence Cetuximab-treated patients with mutated KRAS tumors had a significantly shorter PFS compared with patients with mutated KRAS tumors not receiving cetuximab (8.1 mo. vs 12.5 mo.; P = .003) as well as OS (17.2 months vs 24.9 months; P = .03) 对于携带KRAS突变的肿瘤患者，西妥昔单抗治疗者的PFS显著短于未接受西妥昔单抗治疗者（分别为8.1个月和12.5个月；P=0.003），OS亦显著缩短（分别为17.2和24.9个月；P=0.03）
s356 Sentence The rectum is located within the pelvis, extending from the transitional mucosa of the anal dentate line to the sigmoid colon at the peritoneal reflection; by rigid sigmoidoscopy, the rectum measures between 10 cm and 15 cm from the anal verge 直肠位于骨盆内，自肛门齿状线移行区粘膜延伸至乙状结肠腹膜返折处；硬质乙状结肠镜测量显示，至肛门缘处，直肠长度约为250px-375px
s357 Sentence Local failure rates in the range of 4% to 8% following rectal resection with appropriate mesorectal excision (total mesorectal excision [TME] for low/middle rectal tumors and mesorectal excision at least 5 cm below the tumor for high rectal tumors) have been reported 局部切除失败而需要改为直肠系膜切除术的发生率为4%-8%（中低位直肠癌行全直肠系膜切除术[TME]，对于高位直肠癌，肿瘤下缘距直肠系膜切缘至少5厘米）
s358 Sentence Racial and ethnic differences in overall survival (OS) after adjuvant therapy for rectal cancer have been observed, with shorter OS for blacks compared to whites; factors contributing to this disparity may include tumor position, type of surgical procedure, and various comorbid conditions 一些研究观察了人种和民族差异对于辅助治疗后直肠癌患者总生存率（OS）的影响。一项研究显示，黑人的OS短于白人，这一生存率差异可能与肿瘤位置、手术类型和合并症情况等因素相关
s359 Sentence Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV rectal cancer and recurrent rectal cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria 现招募IV期直肠癌与复发性直肠癌​患者的美国临床试验请参见美国NCI癌症临床试验列表，可根据部位、药物、干预或其他标准进行筛选
s360 Sentence The final results of Intergroup trial 0114 ( CLB-9081 ) showed no survival or local-control benefit with the addition of leucovorin (LV), levamisole, or both to 5-FU administered postoperatively for stage II and III rectal cancers at a median follow-up of 7.4 years CLB-9081研究的最终结果显示，在7.4年的中位随访期内，对于II期和III期结肠癌患者，术后5-FU化疗增添亚叶酸（LV）、左旋咪唑其一或同时增添两者，并不能改善患者的生存率和局部疾病控制
s361 Sentence The final results of Intergroup 0114 ( INT-0114 [CLB-9081]) demonstrated no survival or local control benefit with the addition of leucovorin (LV), levamisole, or both to 5-FU administered postoperatively for stage II and III rectal cancers at a median follow-up of 7.4 years 组间0114研究（INT-0114[CLB-9081]）中位随访7.4年的最终结果显示，对于II期和III期直肠癌患者，在5-FU术后化疗的基础上联用亚叶酸（LV）或左旋咪唑（或同时联用），患者总生存和局部病灶控制率均无差异
s362 Sentence Although based on retrospective data, the American Joint Committee on Cancer and a National Cancer Institute-sponsored panel have recommended that at least 12 lymph nodes be examined in patients with colon and rectal cancer to confirm the absence of nodal involvement by the tumor 美国癌症联合委员会和美国国家癌症研究所资助的研究小组基于回顾性研究数据，建议结直肠癌患者至少活检12枚淋巴结，以确认淋巴结的受累情况
s363 Sentence The location of a rectal tumor is usually indicated by the distance between the anal verge, dentate line, or anorectal ring and the lower edge of the tumor, with measurements differing depending on the use of a rigid or flexible endoscope or digital examination 直肠肿瘤的位置常用肿瘤下缘距肛缘、齿状线或肛管直肠环的距离表示，测量结果与使用的内镜种类（硬质乙状结肠镜或纤维乙状结肠镜）或肛门指检相关
s364 Sentence ERUS using a rigid probe may be similarly accurate in T and regional lymph node (N) staging when compared to ERUS using a flexible scope; however, a technically difficult ERUS may give an inconclusive or inaccurate result for both T stage and N stage 硬式ERUS在T和区域淋巴结（N）分期上的准确性与软式ERUS相似，但遇到技术上的困难时，硬式ERUS可能无法准确评估T、N分期
s365 Sentence For example, MSI-H, also associated with hereditary nonpolyposis rectal cancer, was shown to be associated with improved survival independent of tumor stage in a population-based series of 607 patients with colorectal cancer who were 50 years old or younger at the time of diagnosis 比如，一项以人群为基础的研究调查了607例诊断时年龄小于等于50岁的结直肠癌患者，研究显示，遗传性非息肉病性直肠癌相关的MSI-H和患者的生存率改善独立相关，是独立于肿瘤分期的预后因素
s366 Sentence Among the patients assigned to the postoperative chemoradiation treatment arm, 18% actually had pathologically determined stage I disease and were overestimated by endorectal US to have T3 or T4 or N1 disease. A similar number of patients were possibly overtreated in the preoperative treatment group 术后放化疗组的患者中，病理分期为I期，而结直肠腔内超声高估分期至T3、T4或N1期的患者比例为18%，术前放化疗组被高估分期的患者比例相似
s367 Sentence The Intergroup 86-47-51 trial ( NCCTG-864751 [MAYO-864751]) showed a 10% improvement in OS with the use of continuous-infusion 5-FU (225 mg/m2 /day) throughout the course of radiation therapy when compared with bolus 5-FU (500 mg/m2 times three injections in the first and fifth weeks of radiation) ）显示，在整个放疗期间接受5-FU连续输液（225mg/m2/日）的患者相较于推注5-FU（放疗第1周和第5周每周三次推注500mg/m2）的患者，其OS改善10%
s368 Sentence Retrospective studies of patients with metastatic colorectal cancer have suggested that responses to anti-epidermal growth factor receptor (EGFR) antibody therapy are confined to patients with tumors that harbor wild types of KRAS (i.e., lack activating mutations at code on 12 or 13 of the KRAS gene) 对转移性结直肠癌患者的回顾性研究表明，抗EGFR抗体治疗的缓解作用仅限于肿瘤为KRAS野生型（即在KRAS基因的12号或13号密码子无激活突变者）的患者
s369 Sentence At present, acceptable postoperative therapy for patients with stage II or III rectal cancer not enrolled in clinical trials includes continuous-infusion 5-FU during 45 Gy to 55 Gy pelvic radiation and four cycles of adjuvant maintenance chemotherapy with bolus 5-FU with or without modulation with LV 目前，对于未加入临床试验的II期和III期直肠癌患者，常规术后治疗包括5-FU持续输液化疗同时给予45Gy-55Gy的盆腔放疗、4程静脉推注5-FU辅助维持化疗（联合或不联合亚叶酸）
s370 Sentence Preliminary results, reported in abstract form at the 2011 American Society of Clinical Oncology annual meeting, demonstrated that there was no significant difference in the rates of pCR, sphincter-sparing surgery, or surgical downstaging between the 5-FU and capecitabine regimens or between the regimens with and without oxaliplatin 该研究的初步结果在2011年的美国临床肿瘤学协会年会上公布，结果显示，5-FU和卡培他滨治疗组间、含和不含奥沙利铂治疗组间的pCR率、保留括约肌手术率和外科分期下降程度均无显著变化
s371 Sentence When 5-FU was the only active chemotherapy drug, trials in patients with locally advanced, unresectable, or metastatic disease demonstrated partial responses and prolongation of the time-to-progression (TTP) of disease, as well as improved survival and quality of life for patients receiving chemotherapy compared with best supportive care 5-FU曾是唯一的活性化疗药，当时临床试验中使用5-FU治疗局部晚期、无法切除或转移性病灶，这些临床试验中，对比最佳支持治疗组，接受化疗的患者部分缓解率、疾病进展时间（TTP）延长、生存率和生活质量都得到了改善
s372 Sentence This Italian study randomly assigned 747 patients with resectable, locally advanced, clinically staged T3 or T4 and/or clinical N1 to N2 adenocarcinoma of the mid- to low-rectum to receive either continuous-infusion 5-FU with radiation or to receive the same regimen in combination with oxaliplatin (60 mg/m2 ) 这项意大利临床研究将患有可切除的、局部晚期、临床分期为T3或T4和（或）临床分期达N1至N2期的中低位直肠腺癌患者随机分组，分别接受5-FU连续输液联合放疗，或者在此基础上联合奥沙利铂（60mg/m2）
s373 Sentence Improved radiation planning and techniques can be used to minimize treatment-related complications. These techniques include the use of multiple pelvic fields, prone positioning, customized bowel immobilization molds (belly boards), bladder distention, visualization of the small bowel through oral contrast, and the incorporation of three-dimensional or comparative treatment planning 改善放疗方案和技术可以使这些治疗相关并发症的发生率降到最低，相关的放疗技术包括：多盆腔野放疗、俯卧位放疗、个体化定制肠道固定模具（腹板）、膀胱充盈、口服造影剂观察小肠和三维或对照治疗方案
s374 Sentence Intergroup protocol 86-47-51 ( MAYO-864751 ) demonstrated a 10% improvement in overall survival (OS) with the use of continuous-infusion 5-FU (225 mg/m2 /day throughout the course of radiation therapy) compared with bolus 5-FU (500 mg/m2 /day for 3 consecutive days during the first and fifth weeks of radiation) 组间研究86-47-51（MAYO-864751）显示，5-FU连续输液（联合同步放疗，225mg/m2/天）相较于静脉推注5-FU（放疗开始的第一周和第五周给药，每周连续给三天，500mg/m2/天），患者总生存率（OS）提高了10%
s375 Sentence Grade 3 or 4 acute toxic effects occurred in 27% of the patients in the preoperative-treatment group as compared with 40% of the patients in the postoperative-treatment group ( P = .001); the corresponding rates of long-term toxic effects were 14% and 24%, respectively ( P = .01) 两组长期毒性反应发生率分别为14%和24%（P=0.01）
s376 Sentence Investigators with the Cancer and Leukemia Group B (CALGB) enrolled patients with T1 and T2 rectal adenocarcinomas that were within 10 cm of the dentate line and not more than 4 cm in diameter, and involving not more than 40% of the rectal circumference, onto a prospective protocol, CLB-8984 癌症和白血病B组（CALGB）的研究者招募了T1和T2期直肠腺癌患者，这些患者的肿瘤均位于齿状线250px以内，直径不超过100px且环腔不超过2/5周
s377 Sentence Although the above data demonstrate a benefit with postoperative radiation therapy and 5-FU chemotherapy for patients with stage II and III rectal cancer, a follow-up study to the NSABP-R-01 trial, the NSABP-R-02 study, addressed whether the addition of radiation therapy to chemotherapy would enhance the survival advantage reported in R-01 由上述数据可见，对于II期和III期结肠癌，术后放疗和5-FU化疗会使患者受益，对于NSABP-R-01临床试验的随访研究（NSABP-R-02研究）着重分析了对化疗患者添加放疗是否能够提高R-01研究中患者的生存获益
s378 Sentence The German CAO/ARO/AIO-04 trial randomly assigned 1,236 patients with clinically staged T3 to T4 or clinical node-positive adenocarcinoma within 12 cm from the anal verge to receive either concurrent chemoradiation with 5-FU (week 1 and week 5) or concurrent chemoradiation with 5-FU daily (250 mg/m2 ) and oxaliplatin (50 mg/m2 ) 德国的CAO/ARO/AIO-04临床研究将1,236例临床分期为T3或T4期或有阳性淋巴结的距肛门300px内直肠癌患者随机分配接受放化疗联合5-FU（第1周和第5周）或放化疗联合每日5-FU（250mg/m2）与奥沙利铂（50mg/m2）治疗
s379 Sentence Arm 3 received bolus 5-FU/LV in two 5-day cycles before (5-FU 425 mg/m2 /day; LV 20 mg/m2 /day) and after (5-FU 380 mg/m2 /day; LV 20 mg/m2 /day) radiation therapy, and bolus 5-FU/LV (5-FU 400 mg/m2 /day; LV 20 mg/m2 /day; days 1 to 4, every 28 days) during radiation therapy 第3组在放疗前后分别接受2周期LV联合5-FU推注，每周期5天，放疗前剂量为5-FU 425mg/m2/天，LV 20mg/m2/天；放疗后剂量为5-FU380mg/m2/天，LV20mg/m2/天；放疗期间接受5-FU推注联合亚叶酸（5-FU/LV）化疗（每28天一周期，每周期第1-4天给药，5-FU400mg/m2/天，LV20mg/m2/天）
s380 Sentence A trial conducted by the Dutch Colorectal Cancer Group ( DUT-KWF-CKVO-9504 ) randomly assigned patients with resectable rectal cancers (stages I–IV) to a short course of radiation (5 Gy × 5 days) followed by TME compared with TME alone and demonstrated no difference in OS at 2 years (82% for both arms) 由荷兰结直肠癌研究组（DUT-KWF-CKVO-9504）主导的临床试验中，患有可切除性直肠癌（I-IV期）的患者被随机分组，接受TME或TME加术后短期放疗（5Gy×5天）。研究结果显示，患者的2年OS没有差异（两治疗组均为82%）
s381 Sentence In patients with KRAS wild-type tumors (arm A, n = 367; arm B, n = 362), OS did not differ between treatment groups (median survival, 17.9 months [interquartile range (IQR) 10.3–29.2] in the control group vs 17.0 months [IQR, 9.4–30.1] in the cetuximab group; HR, 1.04; 95% CI, 0.87–1.23, P = .67) KRAS野生型肿瘤患者（A组，n=367；B组：n=362）的组间OS无差异（对照组中位生存17.9个月[四分位区间（IQR）：10.3-29.2]，西妥昔单抗组中位生存17.0个月[IQR：9.4-30.1]；HR，1.04；95%CI，0.87-1.23，P=0.67）
s382 Sentence In contrast to the previous studies, a significantly higher rate of pCR was achieved in patients who received oxaliplatin (17% vs 13%, P = .038). There was no significant difference in rates of overall grades 3 and 4 toxicity, however, diarrhea and nausea and vomiting were more common among those treated with oxaliplatin 和此前研究的不同处在于，奥沙利铂治疗组患者的pCR率有显著的升高（分别为17%和13%，P=0.038），3级和4级的毒性反应发生率没有显著差异，但是奥沙利铂治疗组腹泻、恶心和呕吐的发生率高于对照组
s383 Sentence In addition, a pooled analysis of 3,791 patients enrolled in clinical trials demonstrated that, for patients with T3, N0 disease, the 5-year OS rate with surgery plus chemotherapy (84%) compared favorably with the survival rates of patients treated with surgery plus radiation and bolus chemotherapy (76%) or surgery plus radiation and protracted-infusion chemotherapy (80%) 对3791例进入临床研究的患者行汇总分析，结果发现，对于T3N0的患者，手术加化疗组的5年生存率为84%，相较之下，手术加放疗与推注化疗组、手术加放疗与延长输液化疗组的5年生存率均低于手术加化疗组，分别为76%与80%
s384 Sentence Arm 3 received bolus 5-FU plus LV (5-FU/LV) in two 5-day cycles before (5-FU 425 mg/m2 /day; LV 20 mg/m2 /day) and after (5-FU 380 mg/m2 /day; LV 20 mg/m2 /day) radiation therapy, and bolus 5-FU/LV (5-FU 400 mg/m2 /day; leucovorin 20 mg/m2 /day; days 1 to 4, every 28 days) during radiation therapy 组3放疗前后分别接受2程5-FU/LV静脉推注化疗，各为期5天，分别为放疗前（5-FU 425mg/m2/天，LV 20mg/m2/天），放疗后（ 5-FU 380mg/m2/天，LV 20mg/m2/天），和放疗期间（每28天为一程，每程第1-4天给药，5-FU 400mg/m2/天，LV 20mg/m2/天）
s385 Sentence The patients randomly assigned to IFL plus bevacizumab experienced a significantly better PFS (10.6 months with IFL and bevacizumab compared to 6.2 months with IFL plus placebo; HR for disease progression, 0.54; P &lt;.001) and OS (20.3 months with IFL plus bevacizumab compared to 15.6 months with IFL plus placebo; HR for death, 0.66; P &lt;.001) IFL联合贝伐单抗组患者PFS（IFL联合贝伐单抗组的中位PFS为10.6个月，IFL联合安慰剂组的中位PFS为6.2个月；疾病进展HR为0.54；P<0.001）和OS改善明显（ IFL联合贝伐单抗治疗组中位OS为20.3个月，IFL联合安慰剂治疗组中位PFS为15.6个月；死亡率HR为0.66；P<0.001）
s386 Sentence Arm 3 received bolus 5-FU plus LV in two 5-day cycles before (5-FU 425 mg/m2 /day; LV 20 mg/m2 /day) and after (5-FU 380 mg/m2 /day; LV 20 mg/m2 /day) radiation therapy, and bolus 5-FU plus leucovorin (5-FU/LV) (5-FU 400 mg/m2 /day; LV 20 mg/m2 /day; days 1 to 4, every 28 days) during radiation therapy 第3组在放疗前后分别接受2周期LV联合5-FU推注，每周期5天，放疗前剂量为5-FU 425mg/m2/天，LV 20mg/m2/天；放疗后剂量为5-FU380mg/m2/天，LV20mg/m2/天；放疗期间接受5-FU推注联合亚叶酸（5-FU/LV）化疗（每28天一周期，每周期第1-4天给药，5-FU400mg/m2/天，LV20mg/m2/天）
s387 Sentence The efficacy of postoperative radiation therapy and 5-FU-based chemotherapy for stage II and III rectal cancer was established by a series of prospective, randomized clinical trials from the Gastrointestinal Tumor Study Group ( GITSG-7175 ), the Mayo/North Central Cancer Treatment Group ( NCCTG-794751 ), and the National Surgical Adjuvant Breast and Bowel Project ( NSABP-R-01 ) 由胃肠道肿瘤研究组（GITSG-7175）、梅奥/中北部癌症治疗组（NCCTG-794751）和美国国家外科辅助乳腺和肠道项目（NSABP-R-01）主导的一系列前瞻性随机临床研究显示，对于II期和III期直肠癌患者，术后放疗和基于5-FU的化疗效果得到认可
s388 Sentence A trial of hepatic arterial floxuridine and dexamethasone plus systemic 5-FU/LV compared with systemic 5-FU/LV alone showed improved 2-year PFS (57% vs 42%, P =.07) and OS (86% vs 72%, P = .03) for patients in the combined therapy arm but did not show a significant statistical difference in median survival, compared with systemic 5-FU therapy alone 一项临床研究在进行全身5-FU和亚叶酸化疗的基础上，观察了加用肝动脉氟尿苷与地塞米松化疗的疗效观察，研究显示肝动脉氟尿嘧啶与地塞米松联合全身5-FU和亚叶酸组的2年无进展生存率（PFS）（分别为57%和42%，P=0.07）和总生存率（OS）（分别为86%和72%，P=0.03）相比于单独全身5-FU和亚叶酸组均有改善，但是两组中位生存时间无统计学差异
s389 Sentence In Europe, it is common to deliver preoperative radiation therapy alone in one week (5 Gy x 5 daily treatments) followed by surgery one week later, as compared to the long-course chemoradiation approach in the United States. One reason for this difference is the concern in the U.S. for heightened late effects with high radiation doses per fraction 和美国使用的术前长时间放化疗相比，欧洲常用的方案为在一周内完成术前放疗（5Gy，每天一次，共5天），一周后进行手术，这一差异主要是因为担心出现美国患者中单次高放射剂量引起的晚期副作用
s390 Sentence The German Rectal Cancer Study Group randomly assigned 823 patients with ultrasound (US)-staged T3 orT4 or node-positive rectal cancer to either preoperative chemoradiation or postoperative chemoradiation (50.4 Gy in 28 daily fractions to the tumor and pelvic lymph nodes concurrent with infusional 5-FU 1,000 mg/m^2 daily for 5 days during the first and fifth weeks of radiation therapy) 德国直肠癌研究组招募了823例超声（US）分期为T3-T4期或淋巴结阳性的直肠癌患者，这些患者被随机分组，接受术前放化疗或术后放化疗（对肿瘤和盆腔淋巴结行放疗：50.4Gy，共分为28次，每日一次；同步化疗：于放疗的第1周和第5周，5-氟尿嘧啶（5-FU）1000mg/m2输液，每日一次，每周5天）
s391 Sentence The German Rectal Cancer Study Group randomly assigned 823 patients with ultrasound (US)-staged T3 or T4 or node-positive rectal cancer to either preoperative chemoradiation or postoperative chemoradiation (50.4 Gy in 28 daily fractions to the tumor and pelvic lymph nodes concurrent with infusional 5-FU 1,000 mg/m2 daily for 5 days during the first and fifth weeks of radiation therapy) 德国直肠癌研究组招募了823例超声（US）分期为T3-T4期或淋巴结阳性的直肠癌患者，这些患者被随机分组，接受术前放化疗或术后放化疗（对肿瘤和盆腔淋巴结行放疗：50.4Gy，共分为28次，每日一次；同步化疗：于放疗的第1周和第5周，5-氟尿嘧啶（5-FU）1000mg/m2输液，每日一次，每周5天）
s392 Sentence The German Rectal Cancer Study Group randomly assigned 823 patients with ultrasound (US)-staged T3–T4 or node-positive rectal cancer to either preoperative chemoradiation therapy or postoperative chemoradiation therapy (50.4 Gy in 28 daily fractions to the tumor and pelvic lymph nodes concurrent with infusional 5-fluorouracil (5-FU) 1,000 mg/m^2 daily for 5 days during the first and fifth weeks of radiation therapy) 德国直肠癌研究组招募了823例超声（US）分期为T3-T4期或淋巴结阳性的直肠癌患者，这些患者被随机分组，接受术前放化疗或术后放化疗（对肿瘤和盆腔淋巴结行放疗：50.4Gy，共分为28次，每日一次；同步化疗：于放疗的第1周和第5周，5-氟尿嘧啶（5-FU）1000mg/m2输液，每日一次，每周5天）
s393 Sentence In the per-protocol population, which included only those patients who were free from progression at 12 weeks and randomly assigned to continue treatment or go on a chemotherapy holiday (arm A, n = 467; arm C, n = 511), median survival was 19.6 months (IQR, 13.0–28.1) in arm A and 18.0 months (IQR, 12.1–29.3) in arm C (HR, 1.087, 95% CI, 0.986–1.198) 符合方案集仅包括第12周疾病无进展的患者，这些患者被随机分为持续化疗组或间歇化疗组（A组，n=467；C组，n=511），A组中位生存时间19.6个月（IQR：13.0-28.1），C组中位生存时间18.0个月（IQR：12.1-29.3）（HR，1.087；95%CI，0.986-1.198）
s394 Sentence The FOLFOX6 regimen (oxaliplatin, LV, and 5-FU): Oxaliplatin (85–100 mg/m2 ) administered as a 2-hour infusion on day 1; LV (400 mg/m2 ) administered as a 2-hour infusion on day 1; followed by a loading dose of 5-FU (400 mg/m2 ) IV bolus on day 1, then 5-FU (2,400–3,000 mg/m2 ) administered via ambulatory pump for a period of 46 hours every 2 weeks FOLFOX6化疗方案（奥沙利铂、亚叶酸和5-FU）：第1天奥沙利铂（85-100mg/m2）输液2小时，亚叶酸（400mg/m2）输液2小时； 并静脉用负荷剂量5-FU（400mg/m2），此后46小时静脉泵入5-FU（2,400-3,000mg/m2），每两周重复一次
s395 Sentence The FOLFIRI regimen (LV, 5-FU, and irinotecan): Irinotecan (180 mg/m2 ) administered as a 2-hour infusion on day 1; LV (400 mg/m2 ) administered as a 2-hour infusion on day 1; followed by a loading dose of 5-FU (400 mg/m2 ) IV bolus administered on day 1, then 5-FU (2,400–3,000 mg/m2 ) administered via ambulatory pump for a period of 46 hours every 2 weeks FOLFIRI化疗方案（叶酸、5-FU和伊立替康）：第1天伊立替康（180mg/m2）输液2小时，亚叶酸（400mg/m2）输液2小时，并静脉用负荷剂量5-FU（400mg/m2），此后连续46小时静脉泵入5-FU（2,400-3,000mg/m2），每两周重复一次
s396 Sentence The Arbeitsgemeinschaft Internische Onkologie (AIO) or German AIO regimen (folic acid, 5-FU, and irinotecan): Irinotecan (100 mg/m2 ) administered as a 2-hour infusion on day 1; LV (500 mg/m2 ) administered as a 2-hour infusion on day 1; followed by 5-FU (2,000 mg/m2 ) intravenous (IV) bolus via ambulatory pump administered for a period of 24 hours on a weekly basis four times a year (52 weeks) 德国肿瘤医学协会（AIO）化疗方案（叶酸、5-FU与伊立替康）：第1天伊立替康（100mg/m2）输液2小时和亚叶酸（500mg/m2）输液2小时，此后每年（共52周）4周，每周一次静脉（IV）泵入5-FU（2,000mg/m2）24小时
s397 Sentence The FOLFOX4 regimen (oxaliplatin, LV, and 5-FU): Oxaliplatin (85 mg/m2 ) administered as a 2-hour infusion on day 1; LV (200 mg/m2 ) administered as a 2-hour infusion on day 1 and day 2; followed by a loading dose of 5-FU (400 mg/m2 ) IV bolus, then 5-FU (600 mg/m2 ) administered via ambulatory pump for a period of 22 hours on day 1 and day 2 every 2 weeks FOLFOX4化疗方案（奥沙利铂、亚叶酸和5-FU）：第1天奥沙利铂（85mg/m2）输液2小时，第1天和第2天亚叶酸（200mg/m2）输液各2小时；并静脉用负荷剂量的5-FU（400mg/m2），此后每两周第1天和第2天各连续22小时静脉泵入5-FU（600mg/m2），每两周重复一次
s398 Sentence The Douillard regimen (folic acid, 5-FU, and irinotecan): Irinotecan (180 mg/m2 ) administered as a 2-hour infusion on day 1; LV (200 mg/m2 ) administered as a 2-hour infusion on day 1 and day 2; followed by a loading dose of 5-FU (400 mg/m2 ) IV bolus, then 5-FU (600 mg/m2 ) via ambulatory pump administered for a period of 22 hours on day 1 and day 2 every 2 weeks Douillard化疗方案（叶酸、5-FU与伊立替康）：第1天伊立替康（180mg/m2）输液2小时；第1天和第2天亚叶酸（200mg/m2）输液2小时；第1天输液后静脉用负荷剂量5-FU（400mg/m2）一次，随后第1天和第2天各连续22小时静脉泵入5-FU（600mg/m2），每两周重复一次
s399 Sentence In one retrospective study of the Dutch TME trial for the treatment of rectal cancer, investigators found that the preoperative serum CEA level was normal in the majority of patients with rectal cancer, and yet, serum CEA levels rose by at least 50% in patients with recurrence; the authors concluded that serial, postoperative CEA testing cannot be discarded based on a normal preoperative serum CEA level in patients with rectal cancer 一项荷兰TME回顾性研究发现，大多数结肠癌患者术前血清CEA水平正常，但复发患者的血清CEA至少升高50%。作者建议，不能因直肠癌患者术前血清CEA水平正常，就放弃对患者进行术后CEA水平监测
s400 Sentence In the randomized Multicenter International Study of Oxaliplatin/5-Fluorouracil/Leucovorin in the Adjuvant Treatment of Colon Cancer (MOSAIC) study, the toxic effects and efficacy of FOLFOX4 (a 2-hour infusion of 200 mg/m2 LV, followed by a bolus of 400 mg/m2 5-FU, and then a 22-hour infusion of 600 mg/m2 5-FU on 2 consecutive days every 14 days for 12 cycles, plus a 2-hour infusion of 85 mg/m2 oxaliplatin on day 1, given simultaneously with the LV) were compared with the same 5-FU-leucovorin regimen without oxaliplatin when administered for 6 months 一项国际多中心奥沙利铂/5-FU/亚叶酸对于II期或III期结肠癌的辅助化疗效果研究（MOSAIC[NCT00275210]）对比了6个月的FOLFOX4化疗方案（LV 200mg/m2输液2小时之后推注5-FU 400mg/m2，继而每14天连续2天5-FU 600mg/m2输液22小时，第1天奥沙利铂85mg/m2输液2小时，与LV同时给药）和不含奥沙利铂的5-FU-亚叶酸方案的有效性与毒性反应
s401 Sentence pCR was the primary endpoint (albeit never validated as a true surrogate of OS) in the ACCORD 12/0405-Prodige 2 trial, which randomly assigned 598 patients with clinically staged T2 or T3 or resectable T4 rectal cancer accessible to digital rectal examination to either preoperative radiation (45 Gy in 25 fractions over 5 weeks) with capecitabine (800 mg/m2 twice daily five of every 7 days) or to a higher dose of radiation (50 Gy in 25 fractions over 5 weeks) with the same dose of capecitabine and oxaliplatin (50 mg/m2 weekly) ACCORD12/0405-Prodige2临床试验以pCR作为主要终点（但pCR目前未证实可以代替OS），此研究将598例肛诊可及的T2、T3或可切除的T4期直肠癌患者随机分组接受以下治疗：术前放疗（共5周，45Gy的放射剂量分为25次）联合卡培他滨（每7天中5天，每天两次，800mg/m2），或更高剂量放疗（共5周，50Gy分为25次）联合相同剂量卡培他滨与奥沙利铂（每周50mg/m2）
s402 Sentence In NSABP C-07, 2,492 patients with stage II or III colon cancer were randomly assigned to receive either FLOX (2-hour intravenous infusion of 85 mg/m^2 oxaliplatin on days 1, 15, and 29 of each 8-week treatment cycle, followed by a 2-hour intravenous infusion of 500 mg/m^2 LV plus bolus 500 mg/m^2 5-FU 1 hour after the start of the LV infusion on days 1, 8, 15, 22, 29, and 36, followed by a 2-week rest period, for a total of three cycles [24 weeks]) or the same chemotherapy without oxaliplatin (Roswell Park regimen) NSABPC-07研究共纳入2,492例II期或III期结肠癌患者，患者被随机分组接受FLOX方案（每疗程8周，每疗程第1、15、29天接受奥沙利铂85mg/m22小时静脉输液，每疗程第1、8、15、22、29、36天接受接受LV500mg/m22小时静脉输液，LV输液开始1小时后静脉推注5-FU500mg/m2，每疗程后休息2周，共进行3程化疗[24周]）或不含奥沙利铂的FLOX方案（RoswellPark方案）
s403 Sentence Direct invasion in T4 includes invasion of other organs or other segments of the colorectum as a result of direct extension through the serosa, as confirmed on microscopic examination (e.g., invasion of the sigmoid colon by a carcinoma of the cecum) or, for cancers in a retroperitoneal or subperitoneal location, direct invasion of other organs or structures by virtue of extension beyond the muscularis propria (i.e., respectively, a tumor on the posterior wall of the descending colon invading the left kidney or lateral abdominal wall; or a mid or distal rectal cancer with invasion of prostate, seminal vesicles, cervix, or vagina) T4中的直接浸润包括：肿瘤经浆膜层直接侵犯其他器官或结直肠中其他部分，由镜检确认（如：盲肠肿瘤侵犯乙状结肠）；或腹膜后、腹膜下的肿瘤穿透固有肌层直接浸润其他器官或结构（如降结肠后壁的肿瘤侵犯左肾或侧腹壁、中远端直肠肿瘤侵犯前列腺、精囊、宫颈或者阴道）