引用文本：热依拉·阿布都肉苏力, 高先春, 罗冰, 等. 免疫治疗联合靶向治疗及静脉化学治疗微卫星稳定早发型结肠癌伴多发巨大肝转移患者1例[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(2):255-261.

作者：热依拉·阿布都肉苏力¹，高先春¹，罗冰¹，王鑫林²，喻军¹，王敏³，韩宁⁴，代思甜¹，蒋嘉璐¹，康飞³，聂勇战¹，潘妍^1*

单位：1.第四军医大学西京消化病医院 消化系肿瘤整合防治全国重点实验室，陕西 西安 710032；2.中国人民解放军空军第九八六医院 消化内科，陕西 西安 710032；3.第四军医大学西京医院 核医学科，陕西 西安 710032；4.第四军医大学第二附属医院 消化内科，陕西 西安 710032

Authors：Reyila Abudurousuli¹, Gao Xianchun¹, Luo Bing¹, Wang Xinlin², Yu Jun¹, Wang Min³, Han Ning⁴, Dai Sitian¹, Jiang Jialu¹, Kang Fei³, Nie Yongzhan¹, Pan Yan¹

Unit：1. State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi’an 710032, Shaanxi, China；2. Department of Gastroenterology, Air Force 986(th) Hospital, the Fourth Military Medical University, Xi'an 710032, Shaanxi, China；3. Department of Nuclear Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an 710032, Shaanxi, China；4. Department of Gastroenterology, Second Affiliated Hospital, the Fourth Military Medical University, Xi'an 710032, Shaanxi, China

摘要：

伴肝转移的结直肠癌患者，尤其是早发型（年龄≤50岁）或多发转移灶（转移灶≥3个）者，预后通常较差。而微卫星稳定（microsatellite stability, MSS）患者对免疫检查点抑制剂（immune checkpoint inhibitor, ICI）治疗的反应有限，目前以靶向治疗联合化学治疗（简称化疗）为标准治疗方案。本文报道1例MSS早发型结肠癌伴多发、巨大肝转移患者，西妥昔单抗联合化疗一线治疗12个周期后评估为部分缓解，但无法行根治性手术切除，进入西妥昔单抗联合化疗的持续治疗阶段1（10个周期）。考虑肿瘤负荷仍较重，加用替雷利珠单抗进入持续治疗阶段2（6个周期），并经正电子发射计算机断层显像评估为肝转移灶进一步缩小。然而，由于肿瘤标志物升高，完善肝脏增强磁共振成像检查后提示疾病进展，遂将靶向治疗药物调整为贝伐珠单抗进入二线治疗（8个周期）。截至2025年1月31日，患者总生存期超过24个月，一线治疗无进展生存期达到20个月，二线治疗无进展生存期超过4个月，仍在治疗中。

关键词：结肠癌；微卫星稳定；靶向治疗；免疫治疗；持续治疗

Abstract：

Colorectal cancer patients with liver metastasis, particularly those with early-onset disease (age ≤ 50 years) or multiple metastatic lesions (≥ 3 lesions) generally have a poor prognosis. Patients with microsatellite stability (MSS) tumors demonstrated limited response to immune checkpoint inhibitor (ICI), and targeted therapy combined with chemotherapy remains the standard treatment regimen. This case report presents an early-onset MSS colon cancer patient with multiple, massive liver metastases. After 12 cycles of first-line treatment with cetuximab combined with chemotherapy, the patient achieved partial response but was not eligible for curative surgical resection. The patient then entered the maintenance therapy phase 1 with cetuximab and chemotherapy (10 cycles). Due to the heavy tumor burden, tislelizumab was added for maintenance therapy phase 2 (6 cycles), and positron emission tomography-computed tomography showed further shrinkage of liver metastases. However, due to elevated tumor markers, a liver enhanced magnetic resonance imaging was conducted and the result indicated progressive disease. The targeted therapy was subsequently adjusted to bevacizumab as second-line treatment (8 cycles). As of January 31, 2025, the patient's overall survival time exceeded 24 months, with progression-free survival time of 20 months during first-line treatment and over 4 months during second-line treatment, and the patients remains ongoing treatment.

Key words：Colorectal cancer; Microsatellite stability; Targeted therapy; Immunotherapy; Continuous treatment

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