引用文本：欧阳凯博, 杨梓锋, 蔡观福. 错配修复缺陷/高微卫星不稳定局部晚期或转移性结肠癌免疫联合治疗后手术的疗效分析[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(1): 96-107.

作者：欧阳凯博，杨梓锋，蔡观福

单位：南方医科大学附属广东省人民医院（广东省医学科学院）胃肠外科，广东 广州 510080

Authors：Ouyang Kaibo, Yang Zifeng, Cai Guanfu

Unit：Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, Guangdong, China

摘要：

目的 探讨错配修复缺陷（deficient mismatch repair, dMMR）/高微卫星不稳定（microsatellite instability-high, MSI-H）局部晚期或转移性结肠癌患者接受免疫联合治疗后手术的疗效及预后。方法 回顾性分析2019年1月至2025年3月于南方医科大学附属广东省人民医院接受免疫联合治疗后行手术切除的局部晚期或转移性dMMR/MSI-H结肠癌患者的临床资料（n=8）。收集患者的基线特征、治疗方案、影像学及病理学缓解情况、免疫相关不良事件以及随访数据等，评估该治疗策略的临床效果。结果 纳入的8例患者均为cT₄N_xM_0~1期，其中5例伴有远处转移，2例T_4b期分别浸润空肠和左侧输尿管合并左髂血管，2例诊断为林奇综合征。影像学评估显示，免疫联合治疗后1例（12.5%）达临床完全缓解，3例（37.5%）达部分缓解，客观缓解率为50.0%。 4例（50.0%）发生3级及以上免疫相关不良事件，表现为不完全性肠梗阻（3例）和回肠穿孔（1例），所有病例均无严重手术相关并发症。术后病理评估结果显示，5例（62.5%）肿瘤出现显著退缩，其中2例（25.0%）达病理完全缓解。随访至2025年6月30日，6例均未出现复发，1例肺转移和1例肝转移患者带瘤无进展生存。结论 免疫联合治疗在dMMR/MSI-H型局部晚期或转移性结肠癌患者中显示出较好的抗肿瘤活性，部分患者可获得病理完全缓解，但需密切关注肠梗阻、穿孔等严重免疫相关不良事件的发生。免疫联合治疗后手术的安全性及可行性较高。

关键词：错配修复缺陷/高微卫星不稳定；结肠癌；免疫联合化学治疗；外科手术

Abstract：

Objective To investigate the efficacy and prognosis of surgical resection following combined immunotherapy in patients with  deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) locally advanced or metastatic colon cancer. Method A retrospective analysis was conducted on clinical data from patients with locally advanced or metastatic dMMR/MSI-H colon cancer (n=8) who underwent surgical resection after combined immunotherapy at Guangdong Provincial People's Hospital, Southern Medical University, between January 2019 and March 2025. Baseline characteristics, treatment regimens, radiologic and pathologic responses, immune-related adverse events (irAEs), and follow-up data were collected to evaluate the clinical outcomes of this treatment strategy. Result All 8 enrolled patients had cT₄N_xM_0-1 disease, including 5 with distant metastases. 2 cases with T_4b disease involved invasion of the jejunum and left ureter combined with left iliac vessels, respectively, and 2 had Lynch syndrome. Radiologic assessment showed that 1 patient (12.5%) achieved complete clinical response, 3 (37.5%) achieved partial response, yielding an objective response rate of 50.0% after combined immunotherapy. Grade 3 or higher irAEs occurred in 4 patients (50.0%), presenting as incomplete intestinal obstruction (3 cases) and ileal perforation (1 case), with no severe surgery-related complications observed. Postoperative pathologic evaluation revealed significant tumor regression in 5 cases (62.5%), including 2 (25.0%) with pathologic complete response. Up to June 30, 2025, 6 patients had no recurrence, while 1 patient with lung metastasis and 1 patient with liver metastasis remained progression-free survival with tumor. Conclusion Combined immunotherapy demonstrates promising antitumor activity in locally advanced or metastatic dMMR/MSI-H colon cancer, with some patients achieving pathologic complete response. However, close monitoring is required for severe irAEs such as intestinal obstruction and perforation. Surgery following combined immunotherapy appears safe and feasible.

Key words：Deficient mismatch repair/microsatellite instability-high; Colon cancer; Immunochemotherapy; Surgery

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