2024CSCO临床指南：结直肠癌的诊断和治疗（更新版）-英文解读

2024CSCOClinicalGuidelines:InterpretationofUpdatesinDiagnosisandTreatmentofColorectalCancer

1.BackgroundofGuidelineUpdates

Asoneofthemostauthoritativeclinicalpracticeguidelinesforcolorectalcancer(CRC)inChina,the2024editionofCSCOCRCGuidelinesfullyintegratesthelatesthigh-qualityclinicalevidence,especiallyresearchoutcomesbasedontheChinesepopulation,tofurtheroptimizediagnosisandtreatmentpathways.Theupdatesprioritizeprecisionmedicine,individualizedtreatment,andintegrationofinnovativetherapies,aimingtoenhancesurvivalratesandqualityoflifeforCRCpatientsinChina.

2.UpdatesinDiagnosisSection

2.1ExpandedMolecularBiomarkerTestingRecommendations

BuildingonroutineRAS/BRAFmutationtesting,the2024guidelinesemphasizetheclinicalvalueofHER2amplificationandNTRKfusiontesting.FormetastaticCRCpatients,HER2testingisrecommendedasaroutineitem,particularlyforthosewithRAS/BRAFwild-typestatus,providingevidencefortargetedtherapyselection.NTRKfusiontestingisalsorecommendedforpatientswhohavefailedmultiplelinesoftreatmenttoidentifypotentialbeneficiariesofTRKinhibitortherapy.

Formismatchrepairdeficiency(dMMR)/microsatelliteinstability-high(MSI-H)patients,theguidelinesextenddetectionscopetoincludetumormutationalburden(TMB)evaluation,whichbetterpredictstheefficacyofimmunecheckpointinhibitors(ICIs).

2.2OptimizedApplicationofLiquidBiopsy

The2024guidelinesexpandapplicationscenariosofliquidbiopsy(circulatingtumorDNA,ctDNA).First,ctDNAtestingisrecommendedforpostoperativemonitoringofstageII-IIICRCpatients;persistentpositivectDNAindicateshighrecurrencerisk,guidingadjustmentstoadjuvanttreatmentstrategies.Second,forunresectablemetastaticCRCpatients,liquidbiopsyservesasacomplementarymethodtotissuebiopsyformolecularbiomarkerdetection,especiallywhentissuesamplingischallenging.

2.3RefinedImagingDiagnosisCriteria

Forlocallyadvancedrectalcancer,theguidelinesclarifythevalueofhigh-resolutionMRI,requiringaccurateevaluationoftumorinvasiondepth(Tstage),lymphnodemetastasis(Nstage),andrelationshipwithsurroundingorgans—criticalforformulatingneoadjuvanttreatmentandsurgicalplans.Additionally,PET-CTisrecommendedfordistantmetastasisevaluationinhigh-riskrecurrencepatientstoimprovestagingaccuracy.

3.UpdatesinTreatmentSection

3.1EarlyColorectalCancer(StageI-II)

ForT1N0M0CRCpatients,theguidelinesexpandendoscopicresectionindications.Patientswithwell-differentiatedtumors,nolymphovascularinvasion,andcompleteendoscopicresectioncanavoidradicalsurgery,reducingsurgicaltraumaandimprovingqualityoflife.ForstageIICRCpatientswithlowrecurrencerisk(e.g.,T3N0M0withouthigh-riskfactors),adjuvantchemotherapyisrecommendedtobeomitted,supportedbylarge-scaletrialsshowingnosignificantsurvivaldifferencecomparedtochemotherapygroups.

ForstageIIpatientswithhigh-riskfactors,short-courseadjuvantchemotherapy(3monthsinsteadof6months)isrecommendedforthoseonoxaliplatin-basedregimens,reducingtoxicsideeffectswhilemaintainingtherapeuticefficacy.

3.2LocallyAdvancedColorectalCancer(StageIII)

Forlocallyadvancedrectalcancer,theguidelinesupdateneoadjuvanttreatmentregimens.FordMMR/MSI-Hpatients,neoadjuvantimmunotherapyaloneorcombinedwithshort-courseradiotherapyisrecommended,astrialsshowthisregimenachieveshigherpathologicalcompleteresponse(pCR)ratesandlowerrecurrencerisk.ForpMMR/MSSpatients,combinationofoxaliplatin-basedchemotherapyandtargetedtherapy(e.g.,bevacizumab)inneoadjuvantsettingsisrecommendedtodownstagetumorsandincreaseradicalresectionrates.

ForstageIIIcoloncancerpatients,theguidelinesconfirmadjuvantimmunotherapyvaluefordMMR/MSI-Hpatients,recommendingICIsasanoptionaladjuvanttreatmentafterradicalsurgerytosignificantlyimprovedisease-freesurvival(DFS).

3.3MetastaticColorectalCancer(mCRC)

First-lineTreatment:FordMMR/MSI-HmCRCpatients,first-linetreatmentwithICIsaloneorincombinationisstronglyrecommended,replacingtraditionalchemotherapyregimens,asitachieveslongerprogression-freesurvival(PFS)andoverallsurvival(OS).ForpMMR/MSSmCRCpatientswithRAS/BRAFwild-typestatus,dual-targetedtherapy(bevacizumabpluscetuximab)combinedwithchemotherapyisaddedasanoption,supportedbyevidenceofimprovedsurvivalbenefits.ForHER2-positivemCRCpatientsunsuitableforchemotherapy,first-linedualanti-HER2therapy(trastuzumabpluspertuzumab)isrecommended.

Second-lineandLater-lineTreatment:The2024guidelinesincludenewADCdrugs(e.g.,trastuzumabderuxtecan)forHER2-positivemCRCpatientswhofailedpreviousanti-HER2therapy,providinganewtreatmentoption.ForpatientswithBRAFV600Emutation,combinationofBRAFinhibitor,MEKinhibitor,andanti-EGFRantibodyisrecommendedassecond-linetreatmenttosignificantlyimprovesurvivalrates.Additionally,TRKinhibitorsarerecommendedforpatientswithNTRKfusionregardlessoftreatmentline.

3.4PalliativeCareandSymptomManagement

The2024guidelinesstandardizepalliativecareforCRCpatients,requiringearlypalliativeinterventionforalladvancedpatients,includingpainmanagement,nutritionalsuppo