引用文本：曹玓, 姜武. 中国临床肿瘤学会结直肠癌诊疗指南（2026版）更新要点解读[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(3): 358-363.

作者：曹玓，姜武

单位：中山大学肿瘤防治中心 结直肠科，华南肿瘤学国家重点实验室，肿瘤医学省部共建协同创新中心，广东 广州 510060

Authors：Cao Di, Jiang Wu

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

摘要：

2026版中国临床肿瘤学会（Chinese Society of Clinical Oncology, CSCO）结直肠癌诊疗指南的变化，并非单纯增加治疗方案，而是将多个关键决策节点前移。直肠癌部分细化了新辅助治疗后盆腔磁共振成像的扫描要求、肿瘤床测量方法，以及临床完全缓解、接近临床完全缓解、直肠系膜筋膜和肛管受累的判定，为器官保留和手术平面选择提供了更一致的影像依据。非转移性结肠癌部分，根据临床分期对高微卫星不稳定（microsatellite instability-high, MSI-H）/错配修复缺陷（deficient mismatch repair, dMMR）患者区分直接手术与新辅助免疫治疗，并在Ⅲ期dMMR患者术后辅助治疗中新增FOLFOX（奥沙利铂+氟尿嘧啶+亚叶酸钙）联合阿替利珠单抗。转移性疾病部分，纳武利尤单抗单药或联合伊匹木单抗均被纳入一线Ⅰ级推荐；BRAF V600E靶向联合方案前移至一线，人表皮生长因子受体2（human epidermal growth factor receptor 2, HER2）阳性患者的后线治疗新增瑞康曲妥珠单抗。上述更新要求错配修复/微卫星不稳定性、RAS、BRAF及HER2检测更早介入治疗决策，并对影像标准化和多学科协作提出更高要求。本文结合关键临床研究，对指南更新的证据基础、适用人群及临床实践中的问题进行解读。

关键词：结直肠癌；中国临床肿瘤学会指南；磁共振成像；围手术期治疗；免疫治疗；靶向治疗

Abstract：

The 2026 edition of the Chinese Society of Clinical Oncology (CSCO) guidelines for colorectal cancer is characterized not simply by the addition of new regimens, but by moving several key decision points earlier in the care pathway. For rectal cancer, the guidelines provide more detailed requirements for post-neoadjuvant pelvic magnetic resonance imaging, including image acquisition, tumor-bed measurement, and assessment of clinical complete response (cCR), near-complete clinical response (near-cCR), the mesorectal fascia, and anal involvement. For non-metastatic microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) colon cancer, upfront surgery and neoadjuvant immunotherapy are distinguished according to clinical stage, and FOLFOX (oxaliplatin + fluorouracil + leucovorin ) plus atezolizumab is added as an adjuvant option for stage Ⅲ dMMR disease. For metastatic disease, nivolumab alone or with ipilimumab is recommended in the first-line setting, BRAF V600E-targeted therapy is moved forward, and trastuzumab rezetecan is introduced as a later-line option for human epidermal growth factor receptor 2 (HER2)-positive tumors. These changes require earlier molecular testing, more reproducible imaging, and multidisciplinary planning before treatment begins. This article reviews the supporting evidence, target populations, and practical limitations of these updates.

Key words：Colorectal cancer; Chinese Society of Clinical Oncology guidelines; Magnetic resonance imaging; Perioperative treatment; Immunotherapy; Targeted therapy

注：网络优先发布