结直肠癌新辅助免疫治疗的进展与展望

张钰洋; 刘骞

doi:10.19401/j.cnki.1007-3639.2025.07.003

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结直肠癌新辅助免疫治疗的进展与展望

专家述评 | 更新时间：2025-12-31

- 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
- 中国癌症杂志 2025年35卷第7期页码：642-656
- 作者机构：
  
  国家癌症中心，国家肿瘤临床医学中心研究中心，中国医学科学院北京协和医学院肿瘤医院结直肠外科，北京 100021
- 作者简介：
  
  [ "张钰洋（ORCID: 0000-0003-0617-7467），博士，住院医师。" ]
  [ "刘骞，中国医学科学院北京协和医学院肿瘤医院结直肠外科副主任，主任医师，博士研究生导师。中国抗癌协会结直肠肿瘤整合康复专业委员会主任委员，中国研究型医院学会肿瘤外科专业委员会副主任委员，中国医疗保健国际交流促进会结直肠病学分会副主任委员，中国医师协会结直肠肿瘤专业委员会腹腔镜专业委员会副主任委员，中国医师协会整合医师分会肿瘤专业委员会副主任委员，中国医师协会肛肠医师分会结直肠疾病专业委员会副主任委员，中国医师协会结直肠肿瘤专业委员会青委会副主任委员，北京医师协会肿瘤专家委员会青年委员会副主任委员。长期致力于结直肠外科及快速康复研究。作为负责人承担包括2项国家重点研发计划在内的各级课题20余项。执笔制订《中国结直肠癌诊疗规范》等30余部规范、指南、共识。作为第一作者或通信作者在Advanced Science、Molecular Cancer等SCI收录期刊上发表论文60余篇，作为编委参与国家“十四五”规划《外科学》教材编写。荣获2013年度“中华儿女年度人物”、2021年度“国之名医·卓越建树”等奖项。" ]
- 基金信息：
  
  国家重点研发计划(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)
- DOI：10.19401/j.cnki.1007-3639.2025.07.003
  中图分类号： R735.3+5；R735.3+7
- 收稿：2025-06-04，
  
  修回：2025-07-13，
  
  纸质出版：2025-07-30
- 稿件说明：
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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.

Yuyang ZHANG, Qian LIU. Advances and future perspectives of neoadjuvant immunotherapy in colorectal cancer[J]. China Oncology, 2025, 35(7): 642-656.
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. DOI： 10.19401/j.cnki.1007-3639.2025.07.003.

Yuyang ZHANG, Qian LIU. Advances and future perspectives of neoadjuvant immunotherapy in colorectal cancer[J]. China Oncology, 2025, 35(7): 642-656. DOI： 10.19401/j.cnki.1007-3639.2025.07.003.

摘要

近年来，结直肠癌（colorectal cancer，CRC）新辅助免疫治疗取得了显著进展，特别是在错配修复缺陷/高度微卫星不稳定（mismatch repair deficient/microsatellite instability-high，dMMR/MSI-H）患者中展现出突破性疗效。免疫检查点抑制剂（immune checkpoint inhibitor，ICI）在dMMR/MSI-H患者中实现了高达41%~100%的完全缓解（complete response，CR）率，推动了“豁免手术”和“等待观察”策略的临床应用。然而，占CRC大多数的错配修复完整/微卫星稳定（mismatch repair proficient/microsatellite stable，pMMR/MSS）患者对单药ICI反应有限，需通过联合放疗、化疗或靶向治疗等策略提高疗效，现有研究显示，联合方案可使病理学完全缓解（pathological complete response，pCR）率提升至22%~63%。短程放疗（short-course radiotherapy，SCRT）与免疫治疗的协同效应、双免疫治疗的增效潜力及生物标志物[如

POLE

POLD1

突变、肿瘤突变负荷（tumor mutational burden，TMB）

]

的精准筛选成为研究热点。疗效评估方面，肠镜、影像学、循环肿瘤DNA（circulating tumor DNA，ctDNA）和人工智能（artificial inteligence，AI）技术的整合有望优化治疗决策。未来需进一步探索pMMR/MSS患者的免疫增敏策略、“器官保留”的长期安全性及多学科协作下的个体化治疗。新辅助免疫治疗正重塑CRC的治疗格局，为患者带来生存质量的改善。

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 s

election 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

Keywords

references

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