2024年V2版《美国国家综合癌症网络结肠癌临床实践指南》更新解读OA北大核心CSTPCD

The 2024 V2 guideline update encompasses multiple fields of diagnosis and treatment,with a particular focus on advancements in molecular diagnostic techniques,the latest developments in immunotherapy,and adjustments to comprehensive treatment regimens.In molecular testing,the guideline recommends a more comprehensive genetic analysis for patients with suspected or confirmed metastatic adenocarcinoma,including rare gene mutations/fusions such as POLE/POLDI,RET,and NTRK,and keep monitoring gene mutations like HER2,RAS,and BRAF.Regarding the application of circulating tumor DNA(ctDNA),the guideline adopts a conservative stance and suggests its usage in clinical trials,with special caution in stage Ⅱ or Ⅲ patients and those undergoing adjuvant therapy.In treatment updates,patients with POLE/POLD1 mutations and dMMR/MSI-H are recommended to receive immunotherapy,particularly in cases of unresectable metastases.The restriction of anti-EGFR therapy on left-sided colon tumors has been deleted,broadening its application to all eligible KRAS/NRAS/BRAF wild-type patients.Meanwhile,the use of trastuzumab has also been expanded for all HER2-amplified colon cancer patients.Additionally,the guideline has restructured and updated recommendations for adjuvant chemotherapy in dMMR/MSI-H patients,clarifying the potential limitations of adjuvant chemotherapy in improving survival rates.