Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain.
Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain.
Nat Rev Gastroenterol Hepatol. 2024 Sep;21(9):609-625. doi: 10.1038/s41575-024-00934-z. Epub 2024 May 28.
Despite extensive research and improvements in understanding colorectal cancer (CRC), its metastatic form continues to pose a substantial challenge, primarily owing to limited therapeutic options and a poor prognosis. This Review addresses the emerging focus on metastatic CRC (mCRC), which has historically been under-studied compared with primary CRC despite its lethality. We delve into two crucial aspects: the molecular and cellular determinants facilitating CRC metastasis and the principles guiding the evolution of metastatic disease. Initially, we examine the genetic alterations integral to CRC metastasis, connecting them to clinically marked characteristics of advanced CRC. Subsequently, we scrutinize the role of cellular heterogeneity and plasticity in metastatic spread and therapy resistance. Finally, we explore how the tumour microenvironment influences metastatic disease, emphasizing the effect of stromal gene programmes and the immune context. The ongoing research in these fields holds immense importance, as its future implications are projected to revolutionize the treatment of patients with mCRC, hopefully offering a promising outlook for their survival.
尽管对结直肠癌(CRC)进行了广泛的研究和深入了解,但转移性 CRC 仍然是一个重大挑战,主要是因为治疗选择有限且预后较差。本综述重点关注转移性 CRC(mCRC),尽管 mCRC 的致命性与原发性 CRC 相比,但前者的研究仍不够充分。我们深入探讨了两个关键方面:促进 CRC 转移的分子和细胞决定因素,以及指导转移性疾病演变的原则。首先,我们检查了与 CRC 转移密切相关的遗传改变,并将其与晚期 CRC 的临床显著特征联系起来。其次,我们仔细研究了细胞异质性和可塑性在转移扩散和治疗耐药性中的作用。最后,我们探讨了肿瘤微环境如何影响转移性疾病,强调了基质基因程序和免疫背景的影响。这些领域的持续研究非常重要,因为未来的研究可能会彻底改变 mCRC 患者的治疗方法,有望为他们的生存带来更光明的前景。
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