Biomarkers have revolutionized the management of colorectal cancer (CRC), facilitating early detection, prevention, personalized treatment, and minimal residual disease (MRD) monitoring. This review explores current CRC screening strategies and emerging biomarker applications. Main body. We summarize the landscape of non-invasive CRC screening and MRD detection strategies, discuss the limitations of the current approaches, and highlight the promising potential of novel biomarker solutions. The fecal immunochemical test remained the cornerstone of CRC screening, but its sensitivity has been improved by assays that combined its performance with other stool analytes. However, their sensitivity for advanced adenomas and the patient compliance both remain suboptimal. Blood-based tests promise to increase compliance but require further refinement to compete with stool-based biomarker tests. The ideal scenario involves leveraging blood tests to increase screening participation, and simultaneously promote stool- and endoscopy-based screening among those who are compliant. Once solely reliant on upfront surgery followed by stage and pathology-driven adjuvant chemotherapy, the treatment of stage II and III colon cancer has undergone a revolutionary transformation with the advent of MRD testing after surgery. A decade ago, the concept of using a post-surgical test instead of stage and pathology to determine the need for adjuvant chemotherapy was disruptive. Today, a blood test may be more informative of the need for chemotherapy than the stage at diagnosis. Biomarker research is not just improving, but bringing a transformative change to CRC clinical management. Early detection is not just getting better, but improving thanks to a multi-modality approach, and personalized treatment plans are not just becoming a reality, but a promising future with MRD testing.

中文翻译：

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用于结直肠癌管理的粪便和血液生物标志物：筛查和疾病监测的最新进展


生物标志物彻底改变了结直肠癌 （CRC） 的管理，促进了早期发现、预防、个性化治疗和微小残留病 （MRD） 监测。本综述探讨了当前的 CRC 筛查策略和新兴的生物标志物应用。主体。我们总结了无创 CRC 筛查和 MRD 检测策略的前景，讨论了当前方法的局限性，并强调了新型生物标志物解决方案的前景。粪便免疫化学检测仍然是 CRC 筛查的基石，但通过将其性能与其他粪便分析物相结合的检测，其敏感性得到了提高。然而，他们对晚期腺瘤的敏感性和患者的依从性仍然不理想。基于血液的检测有望提高依从性，但需要进一步改进才能与基于粪便的生物标志物检测竞争。理想的情况是利用血液检查来提高筛查参与度，同时在依从性人群中促进基于粪便和内窥镜检查的筛查。II 期和 III 期结肠癌的治疗曾经完全依赖于前期手术，然后是分期和病理驱动的辅助化疗，随着术后 MRD 检测的出现，II 期和 III 期结肠癌的治疗发生了革命性的转变。十年前，使用术后检查而不是分期和病理来确定辅助化疗需求的概念是破坏性的。今天，血液检查可能比诊断时的阶段更能说明化疗的必要性。生物标志物研究不仅在改进，而且为 CRC 临床管理带来了变革性的变化。 早期检测不仅变得更好，而且由于多模式方法而得到改善，个性化治疗计划不仅成为现实，而且 MRD 检测的前景充满希望。