中国癌症杂志2025，Vol.35Issue(7)：642-656,15.DOI:10.19401/j.cnki.1007-3639.2025.07.003
结直肠癌新辅助免疫治疗的进展与展望
Advances and future perspectives of neoadjuvant immunotherapy in colorectal cancer
摘要
Abstract
In recent years,significant progress has been made in neoadjuvant immunotherapy for colorectal cancer(CRC),particularly demonstrating breakthrough efficacy in mismatch repair deficient/microsatellite instability-high(dMMR/MSI-H)subtypes.Immune checkpoint inhibitor(ICI)has achieved complete response(CR)rates as high as 41%-100%in this patient subgroup,driving the clinical adoption of"surgery-sparing"and"watch-and-wait"strategies.However,the majority of CRC patients with mismatch repair proficient/microsatellite stable(pMMR/MSS)tumors show limited response to ICI monotherapy,necessitating combination approaches with radiotherapy,chemotherapy,or targeted therapies to enhance efficacy.Current studies indicate that such combined regimens can elevate pathological complete response(pCR)rates to 22%-63%.Key research focuses include the synergistic effects of short-course radiotherapy(SCRT)combined with immunotherapy,the potential of dual-ICI therapy,and precision patient selection using biomarkers such as POLE/POLD1 mutations and tumor mutational burden(TMB).For treatment response assessment,the integration of colonoscopy,imaging,circulating tumor DNA(ctDNA)and artificial intelligence(AI)holds promise for optimizing clinical decision-making.Future efforts should prioritize immunomodulation strategies for pMMR/MSS patients,long-term safety evaluation of organ preservation approaches,and multidisciplinary collaboration to advance personalized therapy.Neoadjuvant immunotherapy is reshaping the CRC treatment paradigm,offering improved survival and quality of life for patients.关键词
结直肠癌/免疫治疗/新辅助治疗/免疫检查点抑制剂/生物标志物Key words
Colorectal cancer/Immunotherapy/Neoadjuvant therapy/Immune checkpoint inhibitor/Biomarker分类
医药卫生引用本文复制引用
张钰洋,刘骞..结直肠癌新辅助免疫治疗的进展与展望[J].中国癌症杂志,2025,35(7):642-656,15.基金项目
国家重点研发计划(2022YFC2505003) （2022YFC2505003）
中央高水平医院临床科研业务费和中国医学科学院肿瘤医院合作基金(北京-廊坊-深圳)(CFA202502001). The National Key Research and Development Program(2022YFC2505003) （北京-廊坊-深圳）
National High Level Hospital Clinical Research Funding,Cooperation Fund of CHCAMS(Beijing&Langfang&Shenzhen)(CFA202502001). （Beijing&Langfang&Shenzhen）
