结直肠癌与微卫星不稳定的十个临床问题

Ten clinical questions of colorectal cancer with microsatellite instability

微卫星状态检测已成为结直肠癌(colorectal cancer,CRC)诊疗的常规检查项目,在CRC的全程管理中发挥了重要作用。免疫组织化学和一代测序的检测方式已趋于成熟、二代测序技术为患者提供更多选择,循环肿瘤细胞的微卫星检测研究正在火热进行。目前,微卫星不稳定虽然对林奇综合征筛查、Ⅱ期CRC预后和Ⅳ期CRC免疫治疗的指导作用已基本明确,但对于高危Ⅱ期、Ⅲ期CRC的辅助治疗、Ⅳ期CRC的化疗,以及V-raf鼠肉瘤病毒癌基因同源体B1(V-raf murine sarcoma viral oncogene homolog B1,BRAF)突变的治疗选择目前仍无定论。此外,免疫治疗已经开始了在微卫星不稳定患者辅助治疗和新辅助治疗方面的探索。微卫星不稳定的CRC还存在许多未知和争议,需在临床运用中不断探索。

Test of microsatellite status has become a routine project for diagnosis and treatment for colorectal cancer(CRC),and plays an important role in the overall management of CRC.The detection methods of immunohistochemistry and first-generation sequencing have matured.The next-generation sequencing technology provides patients with more choices,and the researches on the detection of microsatellite status in circulating tumor cells have already provided some good news.At present,the value of microsatellite instability for the Lynch syndrome screening,prognosis of stageⅡCRC and prediction for immunotherapy in stageⅣCRC one clear,but for the adjuvant chemotherapy in high-risk stageⅡandⅢCRC,chemotherapy in stageⅣCRC,and therpy in V-raf murine sarcoma viral oncogene homolog B1(BRAF)mutation metastatic CRC are still controversial.In addition,adjuvant therapy and neoadjuvant therapy for immunotherapy in patients with microsatellite instability have begun.There are still many unknowns and controversies in microsatellite unstable CRC,which need to be continuously explored in clinical applications.