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目的:分析目前中国医生对不可切除的转移性结直肠癌（mCRC）予以姑息治疗的现状。方法:采用随机抽样调查的方法进行问卷调查。开发《转移性结直肠癌临床诊疗现状蓝皮书》专属调研平台，于2023年3月1日至2023年6月30日，对中国华东、华中、华南和东北4大主要区域的综合性manbet官网登录 和肿瘤专科manbet官网登录 的肿瘤内科医生（包括主任ManBetX万博官网地址下载 、副主任ManBetX万博官网地址下载 、主治ManBetX万博官网地址下载 和住院ManBetX万博官网地址下载 ）进行在线问卷发放。调查问卷包含28个问题，内容涉及医生基本信息、接诊mCRC患者的数量、对mCRC患者采用一线至四线及以上治疗的现状、临床治疗mCRC的痛点以及对未来的期盼。由医学专业团队对回收的调查问卷进行数据的质量控制，由统计学专家进行数据清洗整理并进行最后的数据统计分析。结果:共回收303份调查问卷，经过严格质量控制，300份为有效样本。其中综合性manbet官网登录 217位医生（72%），肿瘤专科manbet官网登录 83位医生（28%）；高级职称（含副主任ManBetX万博官网地址下载 及主任ManBetX万博官网地址下载 ）占65%，主治医生占30%，住院医生占5%。在3个月内（平均到每个月），每位医生亲自诊治的结直肠癌患者中，初诊为复发或mCRC（无法根治性切除）患者比例为（46.4±26.6）%，其中肿瘤专科manbet官网登录 诊治比例为（51.6±26.8）%，综合性manbet官网登录 诊治比例为（44.4±26.3）%。mCRC接受各线姑息治疗比例（以一线治疗率为100%计）依次为：一线100%、二线80.3%、三线58.2%、四线及后线治疗35.1%。一线治疗方案选择时的首要参考因素为指南推荐；二线至四线考虑因素均为患者基础疾病及体能状态。临床中使用一线标准治疗方案占比93.8%；二线标准治疗方案占比94.3%；三线标准治疗方案占比73.5%。一线选择靶向治疗方案占比63.6%，免疫治疗方案占比2.8%；二线选择靶向治疗方案占比63.0%，免疫治疗方案占比2.0%；三线标准治疗选择靶向方案占比59.2%，免疫治疗方案占比2.2%；四线标准治疗选择靶向治疗方案占比48.7%，免疫治疗方案占比3.1%。一、二、三和四线及后线姑息治疗的治疗时长分别平均9.6、6.7、4.9和3.7个月。接受一、二线治疗后可以保持良好生活质量的患者超过70%，美国东部肿瘤协作组（ECOG）体力评分维持在0~1分的患者超过60%；而接受三、四线治疗后，可以保持生活质量的患者有50%~60%，ECOG体力评分仍维持在0~1分的患者为40%~50%。调研结果还显示，临床治疗未满足的需求主要为三线治疗药物有效率有限，新药或新型药物组合策略临床研究普及度和参加渠道有限，多学科诊疗参与度有限；期待参与更多的新型药物临床研究和聆听领域内专家的经验分享，期待后续新靶点的突破和新药物的发现来丰富结直肠癌后线治疗药物的选择。结论:本调研报告客观总结了目前我国mCRC患者接受姑息治疗的现状、治疗难点以及一线ManBetX万博官网地址下载 的期望，为mCRC的诊治研究提供了决策的基础和未来的研究方向。

Objective:To analyze the current adoption of palliative care by patients with unresectable metastatic colorectal cancer (mCRC) in China.Methods:From 1 March 2023 to 30 June 2023, a questionnaire survey was conducted by random sampling. An exclusive research platform for the Blue Book on Clinical Diagnosis and Treatment of Metastatic Colorectal Cancer. An online questionnaire was sent to medical oncologists (including chief physicians, associate chief physicians, attending physicians and residents) in general hospitals and oncology hospitals in four major regions of East, Central, South and Northeast China. The questionnaire contained 28 questions requesting basic information about doctors, the number of patients with mCRC, the status of treatment from first to fourth line and beyond, points concerning treatment of pain in patients with mCRC, and expectations for the future. A medical team was responsible for the quality control of data collected, whereas statisticians performed the data cleaning and sorting and statistical analysis.Results:A total of 300 clinical questionnaires were collected, including 217 (72%) from doctors in general hospitals and 83 (28%) from doctors in oncology hospitals. Senior physicians (including associate chief physicians and chief physicians) accounted for 65% of the respondents, attending physicians 30%, and residents 5%. Within 3 months (average for each month), 46.4±26.6% patients were diagnosed with recurrent or unresectable mCRC by each physician, 51.6±26.8% of the patients being in cancer hospitals and 44.4±26.3% in general hospitals. One hundred percent of patients receiving first-line treatment received palliative care, as did 80.3% of those receiving second-line treatment, 58.2% of those receiving third-line treatment, and 35.1% of those receiving ≥fourth-line treatment. The primary factor governing selection of first-line treatment was guideline recommendations, whereas comorbidities and the patients' physical status dictated second line to fourth line treatment. Standard first-line treatment was administered to 93.8% of eligible patients, standard second-line treatment to 94.3%; and standard third-line treatment to 73.5%. First-line therapy included targeted therapy in 63.6% of patients and immunotherapy in 2.8%; second-line therapy included targeted therapy in 63.0% of patients and immunotherapy in 2.0%; third-line therapy included targeted therapy in 59.2% of patients and immunotherapy in 2.2%; and fourth-line therapy included targeted therapy in 48.7% of patients and immunotherapy in 3.1%. First-line treatment lasted an average of 9.6 months, second-line treatment 6.7 months, third-line treatment 4.9 months, and fourth-line treatment 3.7 months. More than 70% of the patients maintained a good quality of life after receiving first and second-line treatment and more than 60% of them had ECOG performance scores of 0–1. After receiving third- and fourth-line treatment, 50%–60% of patients maintained a good quality of life and 40%–50% of them maintained ECOG performance scores of 0–1. The survey also revealed that the main deficiencies in treatment were limited effectiveness of third-line treatment, insufficient availability and opportunity for clinical research, popularity of new drugs or new drug combination strategies, and limited channels for participation in multidisciplinary diagnosis and treatment. Clinicians reported looking forward to participating in more clinical research on new drugs, hearing about the experience of experts in the field, and discovery of new targets and new drugs that increased the options for posterior line treatment of colorectal cancer.Conclusions:This report objectively summarizes the current situation, treatment difficulties, and expectations of frontline physicians concerning management of mCRC, thus providing a basis for decision-making and future direction for the diagnosis and research on treatment of mCRC.