引用文本：许诗语, 戴伟钢, 陈志辉, 等. 中国临床肿瘤学会结直肠癌诊疗指南（2025版）更新要点解读[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(3):292-298.

作者：许诗语，戴伟钢，陈志辉，饶佳伟，李广华，宋新明，陈创奇

单位：中山大学附属第一医院胃肠外科中心，广东 广州 510080

Authors：Xu Shiyu, Dai Weigang, Chen Zhihui, Rao Jiawei, Li Guanghua, Song Xinming, Chen Chuangqi

Unit：Gastrointestinal Surgery Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China

摘要：

中国临床肿瘤学会（Chinese Society of Clinical Oncology, CSCO）结直肠癌诊疗指南（2025版）在前期版本的基础上实现多项关键更新，旨在融合国际循证证据与本土实践经验，优化结直肠癌的精准诊疗路径。该版本重点更新内容包括：在诊断评估方面，提升肝脏细胞特异性造影剂增强磁共振成像（magnetic resonance imaging, MRI）为Ⅰ级推荐，首次纳入循环肿瘤DNA（circulating tumor DNA, ctDNA）-微小残留病灶（minimal residual disease, MRD）检测用于术后复发预测与辅助治疗决策。在治疗策略方面，T_4b期高危结肠癌患者推荐新辅助化疗，辅助治疗进一步细化风险分层。直肠癌治疗路径显著革新，错配修复缺陷（deficient mismatch repair, dMMR）/高微卫星不稳定性（microsatellite instability-high, MSI-H）患者新辅助免疫治疗获Ⅰ级推荐，错配修复完整（proficient mismatch repair, pMMR）/微卫星稳定（microsatellite stability, MSS）患者可根据直肠系膜筋膜状态与保肛可能性实施个体化联合治疗方案，并明确等待观察策略的适用人群及随访规范。在转移性疾病治疗方面，指南重构治疗推荐体系，强调免疫治疗在特定分子亚型（如dMMR/MSI-H、POLE/POLD1突变）中的一线及后线应用，靶向治疗推荐则依据原发灶部位及RAS/BRAF状态进行精细化分层。在遗传性结直肠癌方面，更新了林奇综合征（Lynch综合征）与家族性腺瘤性息肉病管理建议，并将下一代测序技术纳入筛查流程图。整体而言，2025版CSCO指南体现了中国结直肠癌诊疗策略向分子分型指导、精准治疗、多学科协作及免疫整合治疗发展的趋势，为临床实践提供了更具实用性与前瞻性的决策支持。

关键词：结直肠癌；中国临床肿瘤学会指南；循环肿瘤DNA；新辅助治疗；免疫治疗；靶向治疗；遗传性肿瘤；多学科协作

Abstract：

The 2025 edition of the Chinese Society of Clinical Oncology (CSCO) guidelines for the diagnosis and treatment of colorectal cancer incorporates a series of critical updates based on prior versions, aiming to integrate international evidence-based medicine with domestic clinical practice to enhance precision in colorectal cancer management. Key updates include: In diagnostic evaluation, hepatocyte-specific contrast-enhanced magnetic resonance imaging (MRI) is upgraded to a Grade Ⅰ recommendation, and circulating tumor DNA-based minimal residual disease (ctDNA-MRD) detection is introduced for postoperative recurrence prediction and adjuvant therapy guidance. For treatment strategies, neoadjuvant chemotherapy is recommended for high-risk stage T_4b colon cancer, with further risk stratification refined for adjuvant therapy. The therapeutic paradigm for rectal cancer has been significantly revised—neoadjuvant immunotherapy is now a Grade Ⅰ recommendation for patients with deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) tumors, while those with proficient mismatch repair/microsatellite stability (pMMR/MSS) tumors are advised individualized combined regimens based on mesorectal fascia (MRF) status and sphincter preservation potential; indications and follow-up protocols for the watch and wait strategy are also specified. For metastatic disease, the guideline reconstructs therapeutic recommendations, highlighting the role of immunotherapy in molecular subtypes such as dMMR/MSI-H and POLE/POLD1 mutations, and tailoring targeted therapy strategies based on primary tumor location and RAS/BRAF status. In hereditary colorectal cancer, management of Lynch syndrome and familial adenomatous polyposis (FAP) is optimized, and next-generation sequencing (NGS) is incorporated into the genetic screening algorithm. Overall, the 2025 CSCO guidelines reflect a national consensus toward molecular classification-driven precision oncology, multidisciplinary coordination, and integration of immunotherapeutic approaches, offering pragmatic and forward-looking clinical decision-making support.

Key words：Colorectal cancer; Chinese Society of Clinical Oncology guidelines; Circulating tumor DNA; Neoadjuvant therapy; Immunotherapy; Targeted therapy; Hereditary cancer; Multidisciplinary management

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