Expert consensus on the standardized diagnosis and treatment of colon cancer in primary medical service institutions in He’nan Province(2025 Edition)

doi:10.3877/cma.j.issn.2095-3224.2025.05.006

Abstract

Abstract:

This consensus focuses on summarizing the standardized diagnosis and treatment guidelines for colon cancer in primary medical, aiming to provide scientiﬁc and standardized guidance for primary medical service institutions. The content covers the background of consensus development, early screening, clinical manifestations, diagnostic criteria, and evaluation methods of colon cancer. It also elaborates on treatment approaches, including surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy. The consensus highlights the critical role of primary medical workers in colon cancer prevention and treatment, proposing diagnostic pathways and follow-up management recommendations. The goal is to improve the early diagnosis rate and treatment outcomes of colon cancer at the primary medical service institutions, reduce patient mortality, and enhance patients’ quality of life.

Key words: Colon cancer, Primary medical, Standardized diagnosis and treatment, He’nan Province

He’nan Provincial Medical Doctor Association, the Committee of Colorectal Anal Surgeons. Expert consensus on the standardized diagnosis and treatment of colon cancer in primary medical service institutions in He’nan Province(2025 Edition)[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2025, 14(05): 417-426.

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https://zhjzcjbdzzz.cma-cmc.com.cn/EN/Y2025/V14/I05/417

References 72

[1]	郑荣寿，陈茹，韩冰峰，等. 2022年中国恶性肿瘤流行情况分析[J]. 中华肿瘤杂志, 2024, 46(3): 221-231.
[2]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[3]	张明霞，陈琼，刘茵，等. 2010-2019年河南省肿瘤登记地区恶性肿瘤发病与死亡趋势分析[J]. 中国肿瘤, 2024, 33(5): 349-357.
[4]	王福奇，周全博，孙振强，等. 河南地区结直肠癌发病特征分析[J]. 中国全科医学, 2018, 21(3): 269-273.
[5]	徐春光，董云宁. 河南省乡村医疗卫生体系建设:现状、问题与对策[J]. 农村·农业·农民, 2024, (16): 36-38.
[6]	路修德. 河南:推动乡村医疗卫生体系高质量发展[J]. 中国卫生, 2024, (3): 92.
[7]	中华医学会外科学分会结直肠外科学组. 结直肠癌多学科综合治疗协作组诊疗模式中国专家共识(2023版)[J]. 中国实用外科杂志, 2024, 44(1): 1-16.
[8]	Davidson KW, Barry MJ, Mangione CM, et al. Screening for colorectal cancer: US preventive services task force recommendation statement[J]. JAMA, 2021, 325(19): 1965-1977.
[9]	中国抗癌协会家族遗传性肿瘤专业委员会. 中国家族遗传性肿瘤临床诊疗专家共识(2021年版)(4)—家族遗传性结直肠癌[J]. 中国肿瘤临床, 2022, 49(1): 1-5.
[10]	李鹏，王拥军，陈光勇，等. 中国早期结直肠癌及癌前病变筛查与诊治共识[J]. 中国实用内科杂志, 2015, 35(3): 211-227.
[11]	国家卫生健康委员会医疗应急司. 结直肠癌筛查与早诊早治方案(2024年版)[J]. 国际肿瘤学杂志, 2024, 46(10): 917-918.
[12]	乐晨琴，刘成成，胡烨婷，等. 美国一般风险人群结直肠癌筛查指南更新解读[J]. 中华胃肠外科杂志, 2022, 25(9): 826-833.
[13]	Doubeni CA, Major JM, Laiyemo AO, et al. Contribution of behavioral risk factors and obesity to socioeconomic differences in colorectal cancer incidence[J]. J Natl Cancer Inst, 2012, 104(18): 1353-1362.
[14]	Zhang X, Theodoratou E, Li X, et al. Genetically predicted physical activity levels are associated with lower colorectal cancer risk: a Mendelian randomisation study[J]. Br J Cancer, 2021, 124(7): 1330-1338.
[15]	Li J, Yuan Y, Yang F, et al. Expert consensus on multidisciplinary therapy of colorectal cancer with lung metastases (2019 edition)[J]. J Hematol Oncol, 2019, 12(1): 16.
[16]	Muaddi H, Silva S, Choi WJ, et al. When is a ghost really gone? A systematic review and meta-analysis of the accuracy of imaging modalities to predict complete pathological response of colorectal cancer liver metastases after chemotherapy[J]. Ann Surg Oncol, 2021, 28(11): 6805-6813.
[17]	Zech CJ, Korpraphong P, Huppertz A, et al. Randomized multicentre trial of gadoxetic acid-enhanced MRI versus conventional MRI or CT in the staging of colorectal cancer liver metastases[J]. Br J Surg, 2014, 101(6): 613-621.
[18]	Scharitzer M, Ba-Ssalamah A, Ringl H, et al. Preoperative evaluation of colorectal liver metastases: comparison between gadoxetic acid-enhanced 3.0-T MRI and contrast-enhanced MDCT with histopathological correlation[J]. Eur Radiol, 2013, 23(8): 2187-2196.
[19]	Wang Z, Zhao X, Gao C, et al. Plasma-based microsatellite instability detection strategy to guide immune checkpoint blockade treatment[J]. J Immunother Cancer, 2020, 8(2): e001297.
[20]	Shaukat A, Kaltenbach T, Dominitz JA, et al. Endoscopic recognition and management strategies for malignant colorectal polyps: recommendations of the US multi-society task force on colorectal cancer[J]. Gastroenterology, 2020, 159(5): 1916-1934.e1912.
[21]	Tanaka S, Kashida H, Saito Y, et al. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection[J]. Dig Endosc, 2020, 32(2): 219-239.
[22]	Ferlitsch M, Hassan C, Bisschops R, et al. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) guideline-update 2024[J]. Endoscopy, 2024, 56(7): 516-545.
[23]	Matsuda T, Fukuzawa M, Uraoka T, et al. Risk of lymph node metastasis in patients with pedunculated type early invasive colorectal cancer: a retrospective multicenter study[J]. Cancer Sci, 2011, 102(9): 1693-1697.
[24]	Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system[J]. Histopathology, 2020, 76(2): 182-188.
[25]	Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) guideline-update 2022[J]. Endoscopy, 2022, 54(6): 591-622.
[26]	中国抗癌协会，中国抗癌协会大肠癌专业委员会. 中国恶性肿瘤整合诊治指南-结肠癌部分[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(1): 1-12.
[27]	Guan X, Hu X, Jiang Z, et al. Short-term and oncological outcomes of natural orifice specimen extraction surgery (NOSES) for colorectal cancer in China: a national database study of 5055 patients[J]. Sci Bull (Beijing), 2022, 67(13): 1331-1334.
[28]	胡军红，李兴旺，周世灿，等. 2019版结直肠肿瘤经自然腔道取标本手术专家共识解读[J/CD]. 中华结直肠疾病电子杂志, 2020, 9(3): 222-225.
[29]	Matsuda A, Yamada T, Takahashi G, et al. Postoperative infectious complications have a negative oncological impact in patients after stent placement with malignant large bowel obstruction[J]. Int J Colorectal Dis, 2023, 38(1): 2.
[30]	国瑀辰，孙蕊，吴斌，等. 基于单中心数据库的结肠癌术后手术部位感染危险因素分析[J]. 中华胃肠外科杂志, 2022, 25(3): 242-249.
[31]	Rennie O, Sharma M, Helwa N. Colorectal anastomotic leakage: a narrative review of definitions, grading systems, and consequences of leaks[J]. Front Surg, 2024, 11: 1371567.
[32]	Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer[J]. Surgery, 2010, 147(3): 339-351.
[33]	王革非，任建安，黎介寿. 围手术期复杂性腹腔感染及其规范化治疗[J]. 中国实用外科杂志, 2014, 34(2): 137-140.
[34]	Foxtrot Collaborative G. Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial[J]. Lancet Oncol, 2012, 13(11): 1152-1160.
[35]	Seligmann JF, Morton D, Elliott F, et al. Neo-adjuvant FOLFOX with and without panitumumab for patients with KRAS-wt locally advanced colon cancer: results following an extended biomarker panel on the FOxTROT trial embedded phase II population[J]. Ann Oncol, 2025, 36(5): 520-528.
[36]	Morton D, Seymour M, Magill L, et al. Preoperative chemotherapy for operable colon cancer: mature results of an international randomized controlled trial[J]. J Clin Oncol, 2023, 41(8): 1541-1552.
[37]	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, colorectal cancer (PICC): a single-centre, parallel-group, non-comparative, randomised, phase 2 trial[J]. Lancet Gastroenterol Hepatol, 2022, 7(1): 38-48.
[38]	Chalabi M, Verschoor YL, Tan PB, et al. Neoadjuvant immunotherapy in locally advanced mismatch repair-deficient colon cancer[J]. N Engl J Med, 2024, 390(21): 1949-1958.
[39]	Grothey A, Sobrero AF, Shields AF, et al. Duration of adjuvant chemotherapy for stage Ⅲ colon cancer[J]. N Engl J Med, 2018, 378(13): 1177-1188.
[40]	Wells KO, Hawkins AT, Krishnamurthy DM, et al. Omission of adjuvant chemotherapy is associated with increased mortality in patients with T3N0 colon cancer with inadequate lymph node harvest[J]. Dis Colon Rectum, 2017, 60(1): 15-21.
[41]	Ribic CM, Sargent DJ, Moore MJ, et al. Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer[J]. N Engl J Med, 2003, 349(3): 247-257.
[42]	Quah HM, Chou JF, Gonen M, et al. Identification of patients with high-risk stage II colon cancer for adjuvant therapy[J]. Dis Colon Rectum, 2008, 51(5): 503-507.
[43]	André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer[J]. N Engl J Med, 2004, 350(23): 2343-2351.
[44]	André T, Boni C, Navarro M, et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial[J]. J Clin Oncol, 2009, 27(19): 3109-3116.
[45]	Sargent DJ, Marsoni S, Monges G, et al. Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil-based adjuvant therapy in colon cancer[J]. J Clin Oncol, 2010, 28(20): 3219-3226.
[46]	Sinicrope FA, Foster NR, Thibodeau SN, et al. DNA mismatch repair status and colon cancer recurrence and survival in clinical trials of 5-fluorouracil-based adjuvant therapy[J]. J Natl Cancer Inst, 2011, 103(11): 863-875.
[47]	Gao P, Huang XZ, Song YX, et al. Impact of timing of adjuvant chemotherapy on survival in stage III colon cancer: a population-based study[J]. BMC Cancer, 2018, 18(1): 234.
[48]	Pagès F, André T, Taieb J, et al. Prognostic and predictive value of the Immunoscore in stage Ⅲ colon cancer patients treated with oxaliplatin in the prospective IDEA France PRODIGE-GERCOR cohort study[J]. Ann Oncol, 2020, 31(7): 921-929.
[49]	Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer[J]. Ann Oncol, 2016, 27(8): 1386-1422.
[50]	中国医师协会外科医师分会，中华医学会外科分会胃肠外科学组，中华医学会外科分会结直肠外科学组，等. 中国结直肠癌肝转移诊断和综合治疗指南(V2023)[J]. 中华胃肠外科杂志, 2023, 26(1): 1-15.
[51]	Haddad R, Ogilvie RT, Croitoru M, et al. Microsatellite instability as a prognostic factor in resected colorectal cancer liver metastases[J]. Ann Surg Oncol, 2004, 11(11): 977-982.
[52]	Boudjema K, Locher C, Sabbagh C, et al. Simultaneous versus delayed resection for initially resectable synchronous colorectal cancer liver metastases: a prospective, open-label, randomized, controlled trial[J]. Ann Surg, 2021, 273(1): 49-56.
[53]	Yin Z, Liu C, Chen Y, et al. Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): simultaneous or delayed?[J]. Hepatology, 2013, 57(6): 2346-2357.
[54]	Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases[J]. Ann Surg, 1999, 230(3): 309-318; discussion 318-321.
[55]	Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial[J]. Lancet Oncol, 2013, 14(12): 1208-1215.
[56]	Bridgewater JA, Pugh SA, Maishman T, et al. Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis (New EPOC): long-term results of a multicentre, randomised, controlled, phase 3 trial[J]. Lancet Oncol, 2020, 21(3): 398-411.
[57]	André T, Shiu KK, Kim TW, et al. Pembrolizumab in microsatellite-instability-high advanced colorectal cancer[J]. N Engl J Med, 2020, 383(23): 2207-2218.
[58]	Luo HY, Li YH, Wang W, et al. Single-agent capecitabine as maintenance therapy after induction of XELOX (or FOLFOX) in first-line treatment of metastatic colorectal cancer: randomized clinical trial of efficacy and safety[J]. Ann Oncol, 2016, 27(6): 1074-1081.
[59]	Wang DS, Ren C, Li SS, et al. Cetuximab plus FOLFOXIRI versus cetuximab plus FOLFOX as conversion regimen in RAS/BRAF wild-type patients with initially unresectable colorectal liver metastases (TRICE trial): a randomized controlled trial[J]. PLoS Med, 2024, 21(5): e1004389.
[60]	Bond MJG, Bolhuis K, Loosveld OJL, et al. First-line systemic treatment strategies in patients with initially unresectable colorectal cancer liver metastases (CAIRO5): an open-label, multicentre, randomised, controlled, phase 3 study from the Dutch Colorectal Cancer Group[J]. Lancet Oncol, 2023, 24(7): 757-771.
[61]	Ye LC, Liu TS, Ren L, et al. Randomized controlled trial of cetuximab plus chemotherapy for patients with KRAS wild-type unresectable colorectal liver-limited metastases[J]. J Clin Oncol, 2013, 31(16): 1931-1938.
[62]	Ye LC, Wei Y, Zhu DX, et al. Impact of early tumor shrinkage on clinical outcome in wild-type-KRAS colorectal liver metastases treated with cetuximab[J]. J Gastroenterol Hepatol, 2015, 30(4): 674-679.
[63]	Tang W, Ren L, Liu T, et al. Bevacizumab plus mFOLFOX6 versus mFOLFOX6 alone as first-line treatment for RAS mutant unresectable colorectal liver-limited metastases: the BECOME randomized controlled trial[J]. J Clin Oncol, 2020, 38(27): 3175-3184.
[64]	中国临床肿瘤学会结直肠癌专家委员会. RAS野生型转移性结直肠癌抗表皮生长因子受体单抗维持治疗中国专家共识（2024版）[J]. 中华胃肠外科杂志, 2024, 27(4): 316-325.
[65]	Tomasello G, Petrelli F, Ghidini M, et al. FOLFOXIRI plus bevacizumab as conversion therapy for patients with initially unresectable metastatic colorectal cancer: a systematic review and pooled analysis[J]. JAMA Oncol, 2017, 3(7): e170278.
[66]	Diaz LA, Jr., Shiu KK, Kim TW, et al. Pembrolizumab versus chemotherapy for microsatellite instability-high or mismatch repair-deficient metastatic colorectal cancer (KEYNOTE-177): final analysis of a randomised, open-label, phase 3 study[J]. Lancet Oncol, 2022, 23(5): 659-670.
[67]	Le DT, Uram JN, Wang H, et al. PD-1 blockade in tumors with mismatch-repair deficiency[J]. N Engl J Med, 2015, 372(26): 2509-2520.
[68]	Puijk RS, Ruarus AH, Vroomen L, et al. Colorectal liver metastases: surgery versus thermal ablation (COLLISION) - a phase III single-blind prospective randomized controlled trial[J]. BMC Cancer, 2018, 18(1): 821.
[69]	Tinguely P, Laurell G, Enander A, et al. Ablation versus resection for resectable colorectal liver metastases - Health care related cost and survival analyses from a quasi-randomised study[J]. Eur J Surg Oncol, 2023, 49(2): 416-425.
[70]	Blomgren H, Lax I, Näslund I, et al. Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Clinical experience of the first thirty-one patients[J]. Acta Oncol, 1995, 34(6): 861-870.
[71]	Steele SR, Chang GJ, Hendren S, et al. Practice guideline for the surveillance of patients after curative treatment of colon and rectal cancer[J]. Dis Colon Rectum, 2015, 58(8): 713-725.
[72]	Mirshahvalad SA, Hinzpeter R, Kohan A, et al. Diagnostic performance of [(18)F]-FDG PET/MR in evaluating colorectal cancer: a systematic review and meta-analysis[J]. Eur J Nucl Med Mol Imaging, 2022, 49(12): 4205-4217.

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