结直肠癌化疗：基石地位巩固与精准化发展

doi:10.16139/j.1007-9610.2026.02.03

摘要/Abstract

摘要：

作为结直肠癌系统性治疗的基石，化疗（细胞毒性药物治疗）在临床实践中的应用持续精进，范围扩大。在晚期疾病治疗中，化疗与靶向、免疫药物的联合方案不断优化，形成针对不同分子亚型的精准治疗策略，显著提升疗效。在围术期治疗领域，新辅助化疗、全程新辅助治疗(TNT)的应用，以及辅助化疗的精准升级，正在重塑可切除结直肠癌病人的治疗格局。此外，循环肿瘤DNA (ctDNA)等新技术为临床决策及化疗疗效的预测与动态监测提供了可能。本文以化疗为视角，系统解析其参与结直肠癌治疗体系的作用，并探讨其临床挑战与未来方向。

关键词: 结直肠癌, 化疗, 新辅助治疗, 辅助治疗, 姑息治疗

Abstract:

As the cornerstone of systemic treatment for colorectal cancer, chemotherapy (cytotoxic drug therapy) continues to evolve in clinical practice, with its scope and application significantly expanding. In the treatment of advanced disease, the combination of chemotherapy with targeted and immunotherapeutic agents has been continuously optimized, leading to the development of precision treatment strategies tailored to different molecular subtypes, which has markedly improved therapeutic efficacy. In the field of perioperative therapy, the application of neoadjuvant chemotherapy, total neoadjuvant therapy (TNT), and the precision enhancement of adjuvant chemotherapy are reshaping the treatment landscape for patients with resectable colorectal cancer. Furthermore, novel technologies such as circulating tumor DNA offer the potential for prediction and dynamic monitoring of clinical decision and chemotherapy efficacy. From the perspective of chemotherapy, this article systematically analyzed its role in the treatment system for colorectal cancer, and discussed its clinical challenges and future directions.

Key words: Colorectal cancer, Chemotherapy, Neoadjuvant therapy, Adjuvant therapy, Palliative treatment

中图分类号:

姚望, 张俊. 结直肠癌化疗：基石地位巩固与精准化发展[J]. 外科理论与实践, 2026, 31(02): 108-113.

YAO Wang, ZHANG Jun. Chemotherapy for colorectal cancer: consolidation of the cornerstone and advances in precision[J]. Journal of Surgery Concepts & Practice, 2026, 31(02): 108-113.

图/表 2

参考文献 29

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治疗阶段与场景	关键策略	代表方案/研究	核心发现/意义
晚期一线	强化化疗联合	FOLFOXIRI+贝伐珠单抗 (OLIVIA/CAIRO5研究)	提高ORR与切除率，用于转化治疗
	口服TKI替代探索	安罗替尼+CAPOX (ANCHOR研究)	疗效非劣于贝伐珠单抗，提供口服维持选择
	优势人群精准靶向	mFOLFOXIRI+西妥昔单抗 (DEEPER研究)	RAS/BRAF野生型左侧原发mCRC病人的优选方案
	特殊突变运用	康奈非尼+西妥昔单抗+mFOLFOX6 (BREAKWATER研究)	确立BRAF V600E突变病人新的一线标准治疗
	MSI-H/dMMR治疗变革	免疫检查点抑制剂±化疗	免疫治疗成一线优选，化疗转为桥接/诱导作用
围术期	TNT模式	mFOLFIRINOX新辅助治疗 (PRODIGE 23研究)	提高pCR率与长期生存
	新辅助治疗探索	CAPOX/FOLFOX新辅助治疗 (CSCO指南)	T4b期高危病人Ⅲ级推荐，旨在降期
	辅助治疗精准化	ctDNA指导辅助治疗决策 (DYNAMIC-Ⅲ研究)	ctDNA阳性提示高危，但单纯强化化疗未显著改善RFS
疗效监测	动态评估与调整	ctDNA清除监测	早期清除预示疗效较好