Подходы к лечению при легочных метастазах колоректального рака

Легочные метастазы колоректального рака (КРР) представляют значимую клиническую проблему, требующую мультидисциплинарного подхода при определении тактики лечения. На сегодняшний день не существует прогностических шкал и алгоритмов, позволяющих стратифицировать пациентов с метастатическим поражением легких и отдать предпочтение хирургическому лечению, системной или лучевой терапии.
Цель исследования. Систематизировать данные о методах лечения при легочных метастазах КРР и оценить влияние прогностических факторов на показатели выживаемости в данной когорте пациентов. 
Материалы и методы. Проведен анализ публикаций за 2000–2025 гг. в базах PubMed, Google Scholar с использованием ключевых слов: «колоректальный рак», «легочные метастазы», «торакоскопическая хирургия», «стереотаксическая лучевая терапия», «циркулирующая опухолевая ДНК». Исключены исследования, не соответствующие теме, дублирующиеся данные и работы, посвященные метастатическому поражению легких при других нозологиях.
Результаты. На результаты лечения в группе пациентов с легочными метастазами КРР существенное влияние оказывает множество характеристик опухоли. Среди них можно выделить количество метастатических очагов, наличие или отсутствие пораженных медиастинальных лимфатических узлов и уровень раково-­эмбрионального антигена (РЭА). Прогностически неблагоприятным фактором является метастатическое поражение печени в анамнезе и мутации KRAS/BRAF. Локализация первичной опухоли среди пациентов с олигометастатическим КРР также значима: левосторонняя локализация первичной опухоли характеризуется лучшими показателями общей выживаемости, чем при правостороннем поражении.
Заключение. Хирургическая резекция при легочных метастазах является стандартом лечения в группе пациентов с олигометастатическим КРР. Терапевтическая тактика по каждому отдельному случаю должна определяться мультидисциплинарной командой с учетом биологических и генетических особенностей опухоли. При наличии факторов негативного прогноза адъювантная системная терапия способна улучшить отдаленные результаты лечения. Современные подходы лечения при легочных метастазах основаны на данных ретроспективных исследований, что подчеркивает необходимость проведения проспективных рандомизированных исследований и важность разработки стандартизованных алгоритмов.

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