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中华普通外科学文献(电子版) ›› 2026, Vol. 20 ›› Issue (04) : 281 -289. doi: 10.3877/cma.j.issn.1674-0793.2026.04.011

综述

结直肠癌免疫治疗新进展
邹凯翔, 许诗语, 陈创奇()   
  1. 510080 广州,中山大学附属第一医院胃肠外科中心结直肠外科
  • 收稿日期:2025-09-09 出版日期:2026-08-01
  • 通信作者: 陈创奇
  • 基金资助:
    2020年中国抗癌协会基金项目(2020-66); 2021年度广东省卫生健康适宜技术推广项目(202106242104333265); 广州市基础与应用基础研究基金资助项目(202102080387)

Advances in the immunotherapy for colorectal cancer

Kaixiang Zou, Shiyu Xu, Chuangqi Chen()   

  1. Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2025-09-09 Published:2026-08-01
  • Corresponding author: Chuangqi Chen
引用本文:

邹凯翔, 许诗语, 陈创奇. 结直肠癌免疫治疗新进展[J/OL]. 中华普通外科学文献(电子版), 2026, 20(04): 281-289.

Kaixiang Zou, Shiyu Xu, Chuangqi Chen. Advances in the immunotherapy for colorectal cancer[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(04): 281-289.

为探讨结直肠癌免疫治疗的现状及进展,以“Colorectal Cancer”、“Immunotherapy”及各治疗手段对应主题词为核心,通过PubMed等数据库检索2015—2025年间文献,其中免疫检查点抑制剂(ICIs)、过继细胞输注(ACT)、肿瘤疫苗等相关文献共同纳入筛选,最终获得51篇符合标准的研究,进而综合评估上述免疫治疗手段的疗效、安全性及影响治疗效果的因素。ICIs在微卫星高度不稳定/错配修复缺陷(MSI-H/dMMR)转移性或新辅助治疗结直肠癌患者的免疫治疗中具有显著疗效,但对微卫星稳定/错配修复完整(MSS/pMMR)结直肠癌患者的效果则有限,而ICIs联合化疗或放疗及其与靶向治疗联合应用,有望成为MSS/pMMR结直肠癌患者免疫治疗新的突破方向。肿瘤疫苗在激发机体免疫反应方面有一定效果,但尚未达到理想的临床疗效。ACT在初步研究中展现出良好前景,然而在技术层面和安全性方面仍需进一步优化。多种因素如肿瘤微环境、基因突变状态等,对免疫治疗效果有重要影响,合理联合其他治疗方法可能增强免疫治疗的作用。目前,结直肠癌免疫治疗已取得一定成果,治疗手段不断发展,但仍需深入研究其治疗机制、筛选优势人群、优化治疗方案等,以推动结直肠癌免疫治疗迈向新台阶,使患者获益更多。

To explore the current status and progress of immunotherapy for colorectal cancer (CRC), with “Colorectal Cancer”, “Immunotherapy”, and corresponding MeSH terms for various therapeutic modalities as core search keywords to retrieve literature published between 2015 and 2025 from databases including PubMed, with relevant studies on immune checkpoint inhibitors (ICIs), adoptive cell transfer (ACT), and tumor vaccines included for screening. Finally, 51 studies meeting the criteria were selected to comprehensively evaluate the efficacy, safety, and factors influencing the therapeutic effects of the aforementioned immunotherapeutic approaches. The results showed that ICIs exhibited significant efficacy in immunotherapy for patients with microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) metastatic CRC or those undergoing neoadjuvant therapy for CRC, while their therapeutic effect was limited in patients with microsatellite stability/proficient mismatch repair (MSS/pMMR) CRC, and the combined application of ICIs with chemotherapy, radiotherapy, or targeted therapy is expected to become a breakthrough direction for immunotherapy in MSS/pMMR CRC patients. Tumor vaccines demonstrated a certain ability to stimulate the body’s immune response but had not yet achieved the desired clinical efficacy. ACT showed promising prospects in preliminary studies yet required further optimization in terms of technology and safety. Additionally, various factors such as the tumor microenvironment and gene mutation status had significant impact on the efficacy of immunotherapy, and the rational combination of immunotherapy with other treatment methods may enhance its therapeutic effect. Currently, certain achievements have been made in CRC immunotherapy and therapeutic modalities are continuously developing, but in-depth research on therapeutic mechanisms, screening of populations with potential benefits, and optimization of treatment regimens is still necessary to promote CRC immunotherapy to a new stage and bring greater benefits to patients.

表1 部分ICIs临床试验汇总
表2 不同免疫治疗方案的优缺点汇总
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