引用文本：米思源, 康达, 廖毅俊, 等. 2025年美国临床肿瘤学会年会结直肠癌围手术期治疗研究进展：辅助免疫治疗证据、循环肿瘤DNA指导辅助治疗决策与腹膜转移综合治疗策略[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(4): 471-476.

作者：米思源，康达，廖毅俊，唐鑫，陈功，张荣欣

单位：中山大学肿瘤防治中心结直肠科，华南恶性肿瘤防治全国重点实验室，广东省恶性肿瘤临床医学研究中心， 广东 广州 510060

Authors：Mi Siyuan, Kang Da, Liao Yijun, Tang Xin, Chen Gong, Zhang Rongxin

Unit：Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Clinical Research Center for Cancer, Guangzhou 510060, Guangdong, China

摘要：

2025年美国临床肿瘤学会（American Society of Clinical Oncology, ASCO）年会上，多项临床研究结果的公布推动了结直肠癌围手术期精准治疗的发展。在免疫治疗方面，ATOMIC研究首次为Ⅲ期错配修复缺陷结肠癌患者提供了高水平循证证据，研究显示mFOLFOX6（奥沙利铂+氟尿嘧啶+亚叶酸钙）联合阿替利珠单抗能够显著改善3年无病生存率（86.4%比76.6%，P<0.000 1）。与此同时，循环肿瘤DNA（circulating tumor DNA, ctDNA）指导下的辅助治疗策略也迎来了新进展。DYNAMIC-Ⅲ研究提示，尽管对ctDNA阳性患者采用分级强化治疗，但并未带来生存获益（标准治疗方案与强化治疗方案的3年无复发生存率分别为48%比52%，P=0.57）。而对N0147研究留取血液标本的ctDNA分析则再次验证了其在复发风险预测中的价值。在腹膜转移的围手术期综合管理方面，CAIRO6研究探讨了全身系统治疗联合细胞减灭术+腹腔热灌注化疗的潜力，尽管在改良意向性治疗人群中总生存期差异无统计学意义，但在符合方案治疗人群中观察到明显改善的无进展生存期。总体而言，本届ASCO会议的相关研究在辅助免疫治疗、ctDNA动态监测、综合治疗等方面均提供了新的循证依据，为优化结直肠癌围手术期管理奠定了重要基础。

关键词：结直肠癌；围手术期治疗；免疫治疗；循环肿瘤DNA；腹膜转移

Abstract：

At the 2025 American Society of Clinical Oncology (ASCO) annual meeting, multiple clinical trial results advanced the development of precision perioperative treatment for colorectal cancer. In the field of immunotherapy, the ATOMIC trial provided high-level evidence for patients with stage Ⅲ deficient mismatch repair colon cancer. The study demonstrated that modified FOLFOX6 (oxaliplatin+fluorouracil+leucovorin) combined with atezolizumab significantly improved 3-year disease-free survival rates (86.4% vs. 76.6%, P<0.000 1). Meanwhile, adjuvant therapy strategies guided by circulating tumor DNA (ctDNA) also achieved new progress. The DYNAMIC-Ⅲ trial indicated that intensified therapy for ctDNA-positive patients did not translate into survival benefits (3-year recurrence-free survival rates: 48% for standard treatment vs. 52% for intensive treatment regimen, P=0.57). Furthermore, ctDNA analysis of blood specimens from the N0147 trial reaffirmed its predictive value for recurrence risk. In terms of comprehensive perioperative management of peritoneal metastases, the CAIRO6 trial explored systemic therapy combined with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy. Although overall survival did not reach statistical significance in the modified intention-to-treat population, substantial progression-free survival improvement was observed in the per-protocol population. Collectively, the relevant studies presented at this year’s ASCO meeting provided new evidence in adjuvant immunotherapy, ctDNA dynamic monitoring, and integrated treatment approaches, laying a solid foundation for optimizing perioperative management of colorectal cancer.

Key words：Colorectal cancer; Perioperative treatment; Immunotherapy; Circulating tumor DNA; Peritoneal metastases

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