Cheng XF. Molecular profiling-directed individualized adjuvant therapy in colorectal cancer: Bridging consensus guidelines to clinical disparities. World J Gastroenterol 2026; 32(5): 115009 [DOI: 10.3748/wjg.v32.i5.115009]
Corresponding Author of This Article
Xiao-Fei Cheng, MD, PhD, Associate Chief Physician, Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Raod, Hangzhou 310003, Zhejiang Province, China. xfcheng@zju.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Feb 7, 2026; 32(5): 115009 Published online Feb 7, 2026. doi: 10.3748/wjg.v32.i5.115009
Molecular profiling-directed individualized adjuvant therapy in colorectal cancer: Bridging consensus guidelines to clinical disparities
Xiao-Fei Cheng
Xiao-Fei Cheng, Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Cheng XF was responsible for all aspects of this work, including conceptualization and design, literature search and analysis, methodology validation, manuscript drafting, revision and editing, visualization integration, and final approval of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Fei Cheng, MD, PhD, Associate Chief Physician, Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Raod, Hangzhou 310003, Zhejiang Province, China. xfcheng@zju.edu.cn
Received: October 9, 2025 Revised: November 14, 2025 Accepted: December 19, 2025 Published online: February 7, 2026 Processing time: 115 Days and 18.8 Hours
Abstract
Colorectal cancer (CRC) adjuvant therapy is evolving from tumor-node-metastasis stage-based strategies toward molecular-profiling-guided precision medicine. This minireview, based on a comprehensive literature search in PubMed and Web of Science using keywords related to CRC biomarkers and adjuvant therapy (from 2010 to 2025), examines how key biomarkers, including mismatch repair (MMR) status, rat sarcoma viral oncogene homolog/rapidly accelerated fibrosarcoma mutations, consensus molecular subtypes, and circulating tumor DNA, refine risk stratification and treatment selection. Despite consensus guidelines advocating individualized therapy, significant disparities persist in real-world implementation due to technical variability in testing, limited or evolving evidence for specific scenarios (e.g., adjuvant immunotherapy for MMR-deficient/microsatellite instability-high patients, wherein phase 3 trials such as ATOMIC have yet to report mature overall survival data), and health economic barriers. The minireview analyzes gaps across testing, decision-making, and dynamic monitoring phases, and proposes integrated solutions involving technological innovation (e.g., artificial intelligence-integrated multiomics, circulating tumor DNA monitoring), optimized clinical pathways, and supportive health policies. Bridging these gaps requires multidisciplinary collaboration to translate molecular insights into equitable, personalized adjuvant care for CRC patients.
Core Tip: Molecular profiling, including mismatch repair deficiency/microsatellite instability, circulating tumor DNA (ctDNA), and consensus molecular subtypes, refines risk stratification and guides personalized adjuvant therapy in colorectal cancer. Persistent gaps between guidelines and practice stem from technical variability, limited evidence for novel strategies (e.g., ctDNA-guided escalation), and health economic disparities. Bridging these requires integrated artificial intelligence-multiomics decision tools, dynamic ctDNA monitoring, and health policy reforms supporting equitable implementation.
