作者：张荣欣，陈功

单位：中山大学肿瘤防治中心结直肠科，华南恶性肿瘤防治全国重点实验室，广东省恶性肿瘤临床医学研究中心，广东 广州 510060

Authors：Zhang Rongxin, Chen Gong

Unit：Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Clinical Research Center for Cancer, Guangzhou 510060, Guangdong, China

摘要：

在2026年美国临床肿瘤学会（American Society of Clinical Oncology, ASCO）年会报告中，结直肠癌围手术期治疗研究进展主要呈现三大方向：第一，循环肿瘤DNA（circulating tumor DNA, ctDNA）和分子残留病灶（molecular residual disease, MRD）检测正由术后复发风险预测工具，转向辅助治疗疗程与强度的动态决策依据；第二，在错配修复完整/微卫星稳定（proficient mismatch repair/microsatellite stable, pMMR/MSS）局部进展期直肠癌中，新辅助放疗、CAPOX（卡培他滨+奥沙利铂）及免疫治疗的整合策略持续拓展，治疗目标由单纯提高病理完全缓解/临床完全缓解率，转向兼顾长期无病生存、器官保留和功能结局；第三，阿司匹林辅助治疗正由面向全人群的经验性应用策略，逐步转向依据磷脂酰肌醇3-激酶（phosphatidylinositol 3-kinase, PI3K）通路改变、MRD状态等分子特征进行获益人群筛选的精准治疗策略。本文系统梳理上述研究进展，并探讨其对中国结直肠癌临床实践和未来研究设计的启示。

关键词：结直肠癌；围手术期治疗；循环肿瘤DNA；分子残留病灶；局部进展期直肠癌；免疫治疗；阿司匹林

Abstract：

Key perioperative colorectal cancer studies presented at the 2026 American Society of Clinical Oncology (ASCO) annual meeting highlighted three evolving themes. First, circulating tumor DNA (ctDNA) and molecular residual disease (MRD) are expanding from postoperative prognostication to dynamic decision-making regarding the duration and intensity of adjuvant treatment. Second, neoadjuvant strategies integrating radiotherapy, capecitabine plus oxaliplatin (CAPOX), and immune checkpoint blockade continue to evolve in proficient mismatch repair/microsatellite stable (pMMR/MSS) locally advanced rectal cancer, with efficacy assessment extending beyond pathological or clinical complete response to durable disease control, organ preservation, and functional outcomes. Third, research on adjuvant aspirin is shifting from unselected use toward identification of patients most likely to benefit according to phosphatidylinositol 3-kinase (PI3K) pathway alterations and MRD status. This review summarizes these advances and discusses their implications for clinical practice and future trial design in China.

Key words：Colorectal cancer; Perioperative treatment; Circulating tumor DNA; Molecular residual disease; Locally advanced rectal cancer; Immunotherapy; Aspirin

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