结直肠癌个体化诊断与治疗的临床瓶颈及突破策略

Clinical bottlenecks of individual diagnosis and treatment of colorectal cancer and breakthrough strategies

  • 摘要: 我国结直肠癌早期诊断、疗效评估、动态监测、复发转移监测等环节均缺少有效的预警分子病理学标志物和动态监测技术,是临床诊断与治疗瓶颈。传统诊断与治疗手段依赖于单一层面的患者信息,精准度不高。基于系统生物学的医疗模式,开展多项联合诊断,将克服传统单一层面缺点,大幅提高结直肠癌诊断的灵敏度和特异度。对进展期和转移性结直肠癌患者,化疗和靶向治疗的主要挑战是肿瘤基因组的不稳定性和治疗诱导性耐药。故需开展连续动态活组织检查,才能精准指导制订治疗决策。与传统手术切除标本病理学检查比较,液体活组织检查,如循环肿瘤细胞、循环肿瘤DNA检测等技术,具有无创化、可实时动态监测和评估疗效的优点。目前,以上新策略和新技术急需加速进行相关临床试验,通过技术优化,降低成本、提高检测精度,以迅速推广至临床应用。

     

    Abstract: The incidence and mortality of colorectal cancer (CRC) increased rapidly in recent decades and become enormous challenges in China. Lack of effective early warning of molecular markers and dynamic monitoring technology in term of early diagnosis, treatment evaluation, dynamic recurrence and metastasis monitoring are the clinical diagnosis and treatment bottlenecks of CRC . Traditional diagnosis and treatment of CRC rely on a single level of patient information with low accuracy. Based on the system of biology medical model, to carry out a joint diagnostic model, will overcome the traditional problems through a number of multi level information integration of the joint diagnosis model, will significantly improve the sensitivity and specificity of diagnosis of CRC. The major challenge in patients with advanced and metastatic CRC is the instability of the tumor genome and the treatment induced resistance during chemotherapy and targeted therapy. It is necessary to carry out continuous dynamic biopsy in order to accurately guide the development of treatment decisions. Compared with the pathological examination of traditional surgical specimen, liquid biopsy, such as circulating tumor cells, circulating tumor DNA detection technology, with noninvasive, real time dynamic monitoring, could evaluate the efficacy of treatment, and guide the precise individual diagnosis and treatment. Today, the new strategy and new technology need to undergo clinical trials urgency, through technology optimization, reduction of costs and improvement of detection accuracy, would quickly extended to clinical applications in future.

     

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