局部进展期直肠癌精准治疗现状与展望

doi:10.19723/j.issn.1671-167X.2026.02.004

摘要/Abstract

摘要：

局部进展期直肠癌的治疗模式正由传统的“放疗-手术-化疗”固定路径，加速向以精准分层与多学科协作为核心的全程管理体系演进：机器人辅助技术提升了外科操作的精细度与功能保护，分子导向的新辅助与免疫治疗显著提高了疗效并为器官保留创造了条件，人工智能与液体活检实现了风险评估的量化预测与动态监测。这些变革在确保肿瘤学安全的前提下，推动了诊疗策略的微创化、高效化与个体化。本文将针对这一直肠癌精准治疗模式的现状与未来进行总结和展望。

关键词: 直肠肿瘤, 精准医学, 肿瘤辅助疗法, 人工智能, 机器人手术

Abstract:

The treatment paradigm for locally advanced rectal cancer is undergoing a fundamental transformation from the traditional fixed triad of "radiotherapy-surgery-chemotherapy" to a holistic eco-system centered on precision stratification and multidisciplinary collaboration. This review synthesizes the current landscape and future perspectives of this evolution across four key dimensions. First, in surgical innovation, robotic-assisted surgery has demonstrated superiority over conventional laparoscopy in the narrow pelvis. High-quality evidence indicates that robot-assisted surgery (RAS) not only ensures better oncological outcomes, such as lower circumferential resection margin positivity, but also significantly improves functional recovery, including urinary and sexual functions. The field is further advancing towards the integration of intraoperative navigation, fluorescence imaging, and 5G remote collaboration. Second, molecular-guided immunotherapy is reshaping neoadjuvant strategies. While patients with deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) status achieve high rates of clinical complete response with immune checkpoint inhibitors, creating opportunities for organ preservation strategies like "Watch and Wait", research in the proficient mismatch repair/microsatellite stable (pMMR/MSS) population is pivoting towards synergistic radio-immunotherapy combinations to overcome immune-cold microenvironments. Third, artificial intelligence and radiomics are enabling non-invasive quantitative risk stratification and treatment response prediction. Beyond preoperative assessment, computer vision is entering the operating room to identify critical anatomical structures (e.g., nerves, ureters) in real-time and objectively assess surgical quality. Finally, liquid biopsy, particularly circulating tumor DNA, has emerged as a critical biomarker for minimal residual disease. Dynamic monitoring complements morphological imaging to guide decisions on treatment intensification or de-escalation. Collectively, these advances are driving locally advanced rectal cancer management towards a "biologically-driven" and "function-preserving" model. Future efforts must focus on establishing standardized protocols for these technologies and validating their long-term benefits in survival and quality of life through high-quality, multi-center clinical trials.

Key words: Rectal neoplasms, Precision medicine, Neoadjuvant therapy, Artificial intelligence, Robotic surgical procedures

中图分类号:

R735.37

高加勒, 张忠涛. 局部进展期直肠癌精准治疗现状与展望[J]. 北京大学学报（医学版）, 2026, 58(2): 247-250.

Jiale GAO, Zhongtao ZHANG. Current status and future perspectives of precision treatment for locally advanced rectal cancer[J]. Journal of Peking University (Health Sciences), 2026, 58(2): 247-250.

参考文献 21

1	Feng Q , Yuan W , Li T , et al. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): Short-term outcomes of a multicentre randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2022, 7 (11): 991- 1004. doi: 10.1016/S2468-1253(22)00248-5
2	Feng Q , Yuan W , Li T , et al. Robotic vs laparoscopic surgery for middle and low rectal cancer: The REAL randomized clinical trial[J]. JAMA, 2025, 334 (2): 136- 148. doi: 10.1001/jama.2025.8123
3	Aguilera Saiz L , Heerink WJ , Groen HC , et al. Feasibility of image-guided navigation with electromagnetic tracking during robot-assisted sentinel node biopsy: A prospective study[J]. Eur Urol, 2025, 87 (4): 482- 490. doi: 10.1016/j.eururo.2024.07.022
4	Kanno K , Yanai S , Sawada M , et al. Nerve-sparing deep endometriosis surgery with rectal discoid resection using da Vinci SP[J]. Fertil Steril, 2024, 122 (4): 758- 760. doi: 10.1016/j.fertnstert.2024.07.015
5	Emiloju OE , Sinicrope FA . Neoadjuvant immune checkpoint inhibitor therapy for localized deficient mismatch repair colorectal cancer: A review[J]. JAMA Oncol, 2023, 9 (12): 1708- 1715. doi: 10.1001/jamaoncol.2023.3323
6	Chen G , Jin Y , Guan WL , et al. Neoadjuvant PD-1 blockade with sintilimab in mismatch-repair deficient, locally advanced rectal cancer: An open-label, single-centre phase 2 study[J]. Lancet Gastroenterol Hepatol, 2023, 8 (5): 422- 431. doi: 10.1016/S2468-1253(22)00439-3
7	Cercek A , Lumish M , Sinopoli J , et al. PD-1 blockade in mismatch repair-deficient, locally advanced rectal cancer[J]. N Engl J Med, 2022, 386 (25): 2363- 2376. doi: 10.1056/NEJMoa2201445
8	Cercek A , Foote MB , Rousseau B , et al. Nonoperative management of mismatch repair-deficient tumors[J]. N Engl J Med, 2025, 392 (23): 2297- 2308. doi: 10.1056/NEJMoa2404512
9	Hu H , Kang L , Zhang J , et al. Neoadjuvant PD-1 blockade with toripalimab, with or without celecoxib, in mismatch repair-deficient or microsatellite instability-high, locally advanced, colo-rectal cancer (PICC): A single-centre, parallel-group, non-comparative, randomised, phase 2 trial[J]. Lancet Gastroenterol Hepatol, 2022, 7 (1): 38- 48. doi: 10.1016/S2468-1253(21)00348-4
10	Lin ZY , Zhang P , Chi P , et al. Neoadjuvant short-course radiotherapy followed by camrelizumab and chemotherapy in locally advanced rectal cancer (UNION): Early outcomes of a multicenter randomized phase Ⅲ trial[J]. Ann Oncol, 2024, 35 (10): 882- 891. doi: 10.1016/j.annonc.2024.06.015
11	Yang Y , Pang K , Lin G , et al. Neoadjuvant chemoradiation with or without PD-1 blockade in locally advanced rectal cancer: A randomized phase 2 trial[J]. Nat Med, 2025, 31 (2): 449- 456. doi: 10.1038/s41591-024-03360-5
12	Wang Y , Liu Y , Guan X , et al. Neoadjuvant immunotherapy and chemoradiotherapy for mismatch repair proficient locally advanced rectal cancer: A systematic review and meta-analysis[J]. Radiother Oncol, 2025, 211, 111073. doi: 10.1016/j.radonc.2025.111073
13	Xia F , Chen Y , Zhou D , et al. Organ preservation via immunotherapy-based total neoadjuvant therapy in early low rectal cancer (TORCH-E): A multicenter, open-label, single-arm, phase Ⅱ study[J]. Clin Cancer Res, 2025, 31 (23): 4976- 4984. doi: 10.1158/1078-0432.CCR-25-0975
14	Shen H , Jin Z , Chen Q , et al. Image-based artificial intelligence for the prediction of pathological complete response to neoadjuvant chemoradiotherapy in patients with rectal cancer: A systematic review and meta-analysis[J]. Radiol Med, 2024, 129 (4): 598- 614. doi: 10.1007/s11547-024-01796-w
15	Foersch S , Glasner C , Woerl AC , et al. Multistain deep learning for prediction of prognosis and therapy response in colorectal can-cer[J]. Nat Med, 2023, 29 (2): 430- 439. doi: 10.1038/s41591-022-02134-1
16	Han F , Zhong G , Zhi S , et al. Artificial intelligence recognition system of pelvic autonomic nerve during total mesorectal excision[J]. Dis Colon Rectum, 2025, 68 (3): 308- 315. doi: 10.1097/DCR.0000000000003547
17	Wang J , Zeng Z , Li Z , et al. The clinical application of artificial intelligence in cancer precision treatment[J]. J Transl Med, 2025, 23 (1): 120. doi: 10.1186/s12967-025-06139-5
18	Kitaguchi D , Takeshita N , Matsuzaki H , et al. Development and validation of a 3-dimensional convolutional neural network for automatic surgical skill assessment based on spatiotemporal video analysis[J]. JAMA Netw Open, 2021, 4 (8): e2120786. doi: 10.1001/jamanetworkopen.2021.20786
19	Igaki T , Kitaguchi D , Matsuzaki H , et al. Automatic surgical skill assessment system based on concordance of standardized surgical field development using artificial intelligence[J]. JAMA Surg, 2023, 158 (8): e231131. doi: 10.1001/jamasurg.2023.1131
20	Zhou J , Li L , Liu Y , et al. Circulating tumour DNA in predicting and monitoring survival of patients with locally advanced rectal cancer undergoing multimodal treatment: Long-term results from a prospective multicenter study[J]. EBioMedicine, 2025, 112, 105548. doi: 10.1016/j.ebiom.2024.105548
21	Akiyoshi T , Shinozaki E , Maeda Y , et al. ctDNA longitudinal analysis during total neoadjuvant therapy and nonoperative management for locally advanced rectal cancer: A biomarker study from the NOMINATE trial[J]. Clin Cancer Res, 2025, 31 (24): 5188- 5197. doi: 10.1158/1078-0432.CCR-25-1242

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