精准医学在结直肠癌诊治中的共识与争议

The progress and controversy on precision medicine of colorectal cancer

结直肠癌的治疗目前仍以手术切除和综合治疗为主,随着AJCC第8版结直肠癌分期系统的更新,将MSI、KRAS、NRAS、BRAF等分子检测进行了基于高级别"循证医学"证据的重点推荐,结直肠癌已经从传统的基于"群体化"诊治进入了精准的"个体化"医疗。传统的左、右半结肠癌是根据胚胎学、解剖学以及症状学等进行区分,在分子病理学指标及免疫环境检测的基础上,其已经从精准医学的发展中获得了新的定义,成为考虑如何选择靶向治疗和判断预后的关键因素之一。结直肠癌的共识分子亚型已经发布,但如何赋予其更具体的临床可操作性,目前尚存争议。结直肠癌"精准医学"将重新规划癌肿分类、预防筛查、诊断治疗、疗效预测、评估预后等各个临床实践节点,外科医师应该以积极的心态迎接结直肠癌"精准医学"时代的来临。

The main treatment of colorectal cancer is still surgical and comprehensive treatment. The eighth edition of AJCC colorectal cancer staging,recommended MSI,KRAS,NRAS and BRAF testing with high level of ＂evidence-based medicine＂ evidence. The diagnosis and treatment of colorectal cancer has changed from the traditional population based care to personalized precision medicine. The traditional distinction of left- and right-sided colon cancer is based on anatomy,embryology and symptomatology. And based on molecular pathology and immune environment,the sideness of colon cancer has gained a new definition from the development of precision medicine,and become one of the key factors to consider how to choose the targeted therapy and prognosis evaluation. The consensus molecular subtypes of colorectal cancer has been published for several years,but it is still controversial how to give more specific clinical maneuverability. Precision medicine of colorectal cancer will re-plan the cancer classification,prevention and screening,diagnosis and treatment,outcome prediction,and prognosis evaluation. Surgeons should welcome the era of precision medicine for colorectal cancer.