尽管近年来在结直肠癌(CRC)的识别和治疗方面取得了重大进展,目前的标准治疗方案仍有改进的空间.一个值得关注的领域是缺乏可靠的肿瘤标志物来预测治疗效果和指导定制护理。由于其动态,有效,和非侵入性的好处超过组织活检,基于循环肿瘤DNA(ctDNA)的微小或分子残留病变(MRD)的检测有利于CRC患者根治性治疗后药物的临床开发,以及对肿瘤复发和恶性肿瘤分子基因进化的连续监测。ctDNA的检测目前可用于指导CRC中个体的术后辅助治疗决策(升级或降级治疗),更精确地分层临床复发的风险,并在影像学检查之前预测复发的风险,根据大量观察性或前瞻性临床研究。随着越来越清晰的出现,基于术后ctDNA选择治疗方案的可能性,这也提高了CRC临床复发风险评估的准确性。因此,预计ctDNA的鉴定将改变当前处理CRC的框架,并导致个性化,分层精确治疗;然而,额外的确认将需要后续的高质量,prospective,大规模随机对照研究。本文将对MRD的定义和临床意义进行综述,MRD检测的主要适应症和技术挑战,随着CRC根治性切除术后ctDNA检测的临床研究的进展。
Although there has been significant advancement in the identification and management of colorectal cancer (CRC) in recent years, there is still room for improvement in the current standard treatment regimen. One area of concern is the lack of reliable tumor markers to predict treatment efficacy and guide tailored care. Due to its dynamic, effective, and non-invasive benefits over tissue biopsy, the detection of minimal or molecular residual lesions (MRD) based on circulating tumor DNA (ctDNA) is beneficial to the clinical development of drugs for patients with CRC after radical treatment, as well as for continuous monitoring of tumor recurrence and malignancy molecular gene evolution. The detection of ctDNA can currently be used to guide individual postoperative auxiliary treatment decisions (upgrade or downgrade treatment) in CRC, stratify the risk of clinical recurrence more precisely, and predict the risk of recurrence in advance of imaging examination, according to a large number of observational or prospective clinical studies. With increasing clarity comes the possibility of selecting a regimen of treatment based on postoperative ctDNA, which also improves the accuracy of clinical recurrence risk assessment for CRC. Therefore, it is anticipated that the identification of ctDNA would alter the current framework for dealing with CRC and lead to individualized, stratified precision therapy; however, additional confirmation will require subsequent high-quality, prospective, large-scale randomized controlled studies. This article will provide an overview of the definition and clinical significance of MRD, the primary indications and technological challenges for MRD detection, along with the advancement in clinical research about ctDNA detection following radical resection of the CRC.