结直肠癌研究热点之肿瘤异质性研究进展

Advances in research on tumor heterogeneity:a hot topic in colorectal cancer research

结直肠癌(CRC)在发生和发展过程中具有高度异质性,临床上病理分期相同的患者在治疗反应和生存率方面存在显著差异,传统的肿瘤形态学分类不能完全体现结直肠肿瘤异质性,不能适应现代肿瘤治疗的需要。因此,需要依据结直肠肿瘤的异质性特征进行分子分型,指导CRC的精准化治疗策略。目前,临床工作中依据肿瘤TNM分期、肿瘤分级、微卫星状态、脉管神经束浸润等参数,制定CRC治疗方案和预测预后。KRAS、NRAS和BRAF的突变状态也在转移性CRC患者中常规检测,以预测对抗表皮生长因子受体靶向治疗的反应。近年,4种不同的CRC分子分型已被描述,它们具有治疗和预后的相关性。此外,炎症浸润的特征研究显示,在不同类型的结直肠肿瘤中,炎症细胞的数量和位置亦存在显著差异。总之,这些参数都有助于将患者分为不同的治疗亚组和预后亚组,并为CRC的个体化和精准治疗提供依据。

Colorectal cancer(CRC)is highly heterogeneous in the process of occurrence and development.Clinically,patients with the same pathological stage have significant differences in treatment response and survival rate.The traditional tumor morphological classification can not fully reflect the heterogeneity of colorectal tumors and can not meet the needs of modern tumor treatment.Therefore,it is necessary to carry out molecular typing according to the heterogeneity of colorectal tumors to guide the precise treatment strategy of CRC.At present,clinical work is based on tumor TNM stage,tumor grade,microsatellite status,vascular and neural tract infiltration and other parameters to formulate the treatment plans for CRC and predict the prognosis.The mutation states of KRAS,NRAS and BRAF are also routinely detected in patients with metastatic CRC to predict the response to anti-epidermal growth factor receptor targeted therapy.In recent years,four different molecular types of CRC have been described,which have correlation between treatment and prognosis.In addition,the studies on the characteristics of inflammatory infiltration show that there are significant differences in the number and location of inflammatory cells in different types of colorectal tumors.In conclusion,all these parameters help to divide the patients into different treatment subgroups and prognosis subgroups,and provide a basis for the individualized and precise treatment of CRC.