Zhang Jing, Wang Xicheng, Shen Lin
Multidisciplinary Collaboration Group, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Jun 25;21(6):716-720.
Colorectal cancer is the third tumor in the world, and nearly half of the stage II( and III( patients undergoing radical resection develop relapse. At present, the survival benefit of follow-up strategy is still unclear, partly due to the neglect of the risk of recurrence and the factors affecting prognosis. Studies found that microsatellite status, BRAF and RAS genotype had certain value for prognosis of colorectal cancer patients after radical resection, but there were differences in prediction among these three factors. Patients with high-frequency microsatellite instability in stage II( have good prognosis, so the follow-up strategy in this set of patients can be appropriately simplified. Locally advanced colorectal cancer patients with BRAF-V600E mutations usually have poor survival after recurrence, and survival benefit appears minimal by intensive follow-up strategy. Besides, standard follow-up strategy, or less intensive follow-up strategy seems an acceptable option for patients with this subtype. In contrast, for patients with wild-type BRAF and RAS in stage II( or III(, the prognosis is usually good after recurrence. Such patients are sensitive to both systemic treatment and local therapy. Therefore, for patients with wild-type BRAF and RAS, early detection of recurrence by intensive follow-up strategy can potentially increase the possibility of second radical resection and prolong survival. It is of clinical significance to explore the feasibility of individualized follow-up strategy for patients with different biological characteristics. In addition, the establishment of individual risk prediction model should take clinical, pathological and molecular features into consideration. Combination of TNM staging and molecular markers for more stratified management and establishment of individualized follow-up system are clinically meaningful in the future.
结直肠癌是全球第三大肿瘤，近一半接受根治性切除的Ⅱ期和Ⅲ期患者会出现复发。目前，随访策略的生存获益仍不明确，部分原因是对复发风险和影响预后的因素有所忽视。研究发现，微卫星状态、BRAF和RAS基因分型对结直肠癌根治术后患者的预后有一定价值，但这三个因素在预测方面存在差异。Ⅱ期高频微卫星不稳定的患者预后良好，因此这组患者的随访策略可适当简化。BRAF-V600E突变的局部进展期结直肠癌患者复发后的生存通常较差，强化随访策略的生存获益似乎微乎其微。此外，对于该亚型患者，标准随访策略或不太强化的随访策略似乎是可接受的选择。相比之下，Ⅱ期或Ⅲ期BRAF和RAS野生型的患者复发后的预后通常较好。这类患者对全身治疗和局部治疗均敏感。因此，对于BRAF和RAS野生型患者，通过强化随访策略早期发现复发可能会增加二次根治性切除的可能性并延长生存期。探索针对不同生物学特征患者的个体化随访策略的可行性具有临床意义。此外，个体风险预测模型的建立应考虑临床、病理和分子特征。将TNM分期与分子标志物相结合进行更分层的管理并建立个体化随访系统在未来具有临床意义。
