Chuang Jen-Pin, Chen Yen-Chen, Wang Jaw-Yuan
Chiayi Hospital, Ministry of Health and Welfare, Chiayi, Taiwan.
Department of Surgery, Faculty of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Kaohsiung J Med Sci. 2025 Feb;41(2):e12926. doi: 10.1002/kjm2.12926. Epub 2024 Dec 24.
Colorectal cancer is a leading cause of cancer-related morbidity and mortality worldwide, with more than 1.9 million new cases reported in 2020, and is associated with major survival challenges, particularly in patients with locally advanced colon cancer (LACC). LACC often involves T4 invasion or extensive nodal involvement and requires a multidisciplinary approach for management. Radical surgery followed by adjuvant chemotherapy remains the primary treatment strategy for LACC. However, achieving complete tumor resection (R0) is challenging because locally advanced colon tumors typically infiltrate adjacent organs or nodes. Advancements in LACC treatment have involved neoadjuvant chemotherapy (NACT), neoadjuvant chemoradiotherapy (NACRT), and neoadjuvant immunotherapy (NAIT). Studies such as FOxTROT and PRODIGE 22 have demonstrated that NACT, particularly with FOLFOX or CAPOX, can lead to major tumor downstaging, improved survival rates, and increased R0 resection rates. Predictive biomarkers, such as mismatch repair (MMR) status and T stage, are crucial in identifying candidates who may benefit from NACT. NACRT has demonstrated promise in enhancing tumor regression, particularly in patients with rectal cancer, underscoring its potential for use with LACC. NAIT, particularly for deficient MMR tumors, has emerged as a novel approach, with studies such as NICHE-2 and NICHE-3 reporting excellent pathologic responses and pathologic complete responses. Integrating these therapies can enhance the surgical and survival outcomes of patients with LACC, highlighting the importance of personalized treatment strategies based on tumor characteristics and response to neoadjuvant interventions. This review discusses the evolving landscape of LACC management, focusing on optimizing treatment approaches for improved patient outcomes.
结直肠癌是全球癌症相关发病和死亡的主要原因，2020年报告的新发病例超过190万例，并且与重大的生存挑战相关，特别是在局部晚期结肠癌（LACC）患者中。LACC通常涉及T4侵犯或广泛的淋巴结受累，需要多学科方法进行管理。根治性手术联合辅助化疗仍然是LACC的主要治疗策略。然而，实现肿瘤完全切除（R0）具有挑战性，因为局部晚期结肠肿瘤通常会侵犯邻近器官或淋巴结。LACC治疗的进展包括新辅助化疗（NACT）、新辅助放化疗（NACRT）和新辅助免疫治疗（NAIT）。FOxTROT和PRODIGE 22等研究表明，NACT，特别是使用FOLFOX或CAPOX方案，可导致肿瘤显著降期，并提高生存率和R0切除率。预测生物标志物，如错配修复（MMR）状态和T分期，对于识别可能从NACT中获益的患者至关重要。NACRT已显示出增强肿瘤退缩的前景，特别是在直肠癌患者中，这突出了其在LACC治疗中的潜在应用价值。NAIT，特别是针对错配修复缺陷肿瘤，已成为一种新方法，NICHE-2和NICHE-3等研究报告了出色的病理反应和病理完全缓解。整合这些疗法可提高LACC患者的手术和生存结局，凸显了基于肿瘤特征和对新辅助干预反应的个性化治疗策略的重要性。本综述讨论了LACC管理的不断演变的格局，重点是优化治疗方法以改善患者结局。
