新辅助免疫治疗在局部晚期结肠癌中的应用：是否适合普通患者？

近年来，癌症治疗方式不断推陈出新，除了传统的手术、化疗和放疗，免疫治疗逐渐成为治疗多种癌症的重要选择之一。免疫治疗通过激活人体自身的免疫系统来识别和消灭癌细胞，对于某些特殊类型的结肠癌患者（如错配修复缺陷型，简称 dMMR 结肠癌）表现出了显著的治疗效果，并正在逐步应用于新辅助治疗（即手术前的治疗）中。今天，我们将通过最新的 NICHE-2 研究，探讨新辅助免疫治疗是否适合普通患者。

在 NICHE-2 研究中，研究人员选取了局部晚期 dMMR 结肠癌患者，并使用了一种新辅助免疫治疗方案：在手术前仅使用一次 ipilimumab（易普利单抗）和两次 nivolumab（纳武单抗）。研究结果显示，所有患者在接受此治疗方案后，手术切除的病理检查中，有68%的患者达到了病理完全缓解（pCR），即手术切除的组织中没有发现癌细胞，另有95%的患者肿瘤组织残存比例非常低（即达到主要病理反应，MPR）。此外，患者在随访3年内无一例复发，3年无病生存率（DFS）达到了100%。这一结果表明，对于 dMMR 结肠癌患者来说，新辅助免疫治疗的效果非常显著。

然而，普通患者在选择治疗方案时需要注意以下几点：

适用范围有限：目前的新辅助免疫治疗仅适用于错配修复缺陷（dMMR）或微卫星不稳定（MSI-H）的结肠癌患者。这类患者占结肠癌患者总数的比例相对较小，而对于绝大多数的结肠癌患者（包括没有dMMR特征的患者），免疫治疗可能没有同样的效果。因此，是否适用新辅助免疫治疗需要经过详细的基因检测和医生评估。

副作用与风险：虽然免疫治疗通常比化疗的副作用轻，但也可能引起免疫相关的不良反应，如皮肤、肠道、肝脏等器官的炎症。这些副作用虽然较为少见，但仍需在专业医生的指导下进行监控和处理。

费用较高：免疫治疗的费用较高，可能不在所有医保范围内报销，因此在选择前需要考虑经济承受能力。

综上所述，新辅助免疫治疗作为一种前沿的治疗手段，对于 dMMR 结肠癌患者来说是非常值得考虑的选择。然而，普通患者在决定是否使用该治疗方案时，应在医生的指导下进行全面评估，并权衡治疗效果、副作用及经济成本等因素。如果您或您的家人被诊断为结肠癌，建议先进行详细的基因检测，了解自身肿瘤的具体类型，再与医生沟通确定最合适的治疗方案。这样，才能为每位患者量身定制最科学、最有效的治疗策略。

In recent years, cancer treatment options have been evolving rapidly. In addition to traditional methods such as surgery, chemotherapy, and radiotherapy, immunotherapy has gradually become an important choice for treating various cancers. Immunotherapy works by activating the body‘s own immune system to recognize and eliminate cancer cells. For certain specific types of colon cancer, such as mismatch repair-deficient (dMMR) colon cancer, immunotherapy has shown significant therapeutic effects and is increasingly being applied in neoadjuvant treatment (pre-surgical treatment). Today, we will discuss whether neoadjuvant immunotherapy is suitable for ordinary patients based on the findings from the latest NICHE-2 study.

In the NICHE-2 study, researchers selected patients with locally advanced dMMR colon cancer and used a neoadjuvant immunotherapy regimen that involved one dose of ipilimumab and two doses of nivolumab prior to surgery. The results showed that after this treatment regimen, 68% of the patients achieved a pathological complete response (pCR), meaning no cancer cells were found in the surgically removed tissues, while 95% of the patients showed a significant reduction in tumor tissue (major pathological response, MPR). Furthermore, during a 3-year follow-up period, none of the patients experienced recurrence, and the 3-year disease-free survival (DFS) rate reached 100%. These results suggest that neoadjuvant immunotherapy is highly effective for patients with dMMR colon cancer.

However, ordinary patients should consider the following factors when choosing a treatment plan:

Limited Scope of Application: Currently, neoadjuvant immunotherapy is only suitable for colon cancer patients with dMMR or microsatellite instability-high (MSI-H) characteristics. These patients represent a relatively small proportion of the total number of colon cancer cases. For the majority of colon cancer patients (including those without dMMR characteristics), immunotherapy may not produce the same results. Therefore, whether to use neoadjuvant immunotherapy should be determined after thorough genetic testing and evaluation by a physician.

Side Effects and Risks: Although immunotherapy typically has fewer side effects compared to chemotherapy, it can still cause immune-related adverse reactions, such as inflammation of the skin, intestines, or liver. Although these side effects are relatively rare, they still need to be monitored and managed under the guidance of a professional doctor.

High Cost: Immunotherapy is expensive and may not be covered by all insurance plans. Thus, it is important to consider the financial burden before making a decision.

In summary, neoadjuvant immunotherapy is a promising treatment option for patients with dMMR colon cancer. However, ordinary patients should undergo a comprehensive evaluation under the guidance of a physician before deciding whether to use this treatment plan, taking into account factors such as treatment efficacy, side effects, and financial costs. If you or your family members are diagnosed with colon cancer, it is recommended to first conduct detailed genetic testing to understand the specific type of tumor and then discuss with your doctor to determine the most appropriate treatment plan. This will ensure that each patient receives the most scientific and effective personalized treatment strategy.