Deig Christopher R, Mendonca Marc S, Lautenschlaeger Tim
Department of a Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202.
b Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana 46202.
Radiat Res. 2017 Mar;187(3):333-338. doi: 10.1667/RR14613.1. Epub 2017 Feb 10.
Lung cancer is the leading cause of cancer deaths worldwide, with smoking as the main risk factor. The use of low-dose computed tomography (LDCT) as a screening method has shown a 20% lung cancer specific mortality benefit; however, widespread implementation is estimated to add $1.3-$2.0 billion in annual national health care expenditures. Blood-based microRNAs (miRNAs) have been investigated in detail and found to be potentially useful biomarkers indicating the presence of lung cancer, especially when used as a companion test to LDCT. Testing for miRNAs and circulating tumor DNA (ct-DNA) in the blood are anticipated to become more affordable in the near future, and therefore these potentially sensitive methods could serve as first-line screening modalities prior to obtaining LDCT and definitive diagnostic tests for lung cancer. Furthermore, miRNAs may shed light not only on the tumor burden, but also perhaps on tumor aggressiveness, histology, treatment response and the patient's overall survival. In the near future, analysis of ct-DNA may reveal somatic mutations beyond EGFR, tumor burden and the presence of occult progression of disease. In theory, these biomarkers may also help oncologists to elucidate the tumor response to radiotherapy, and in the future, may assist the radiation oncologist in making data-driven treatment decisions and providing patients with quantitative information regarding their treatment response.
肺癌是全球癌症死亡的主要原因，吸烟是主要风险因素。使用低剂量计算机断层扫描（LDCT）作为筛查方法已显示出肺癌特异性死亡率降低20%的益处；然而，据估计广泛实施该方法每年将增加13亿至20亿美元的国家医疗保健支出。基于血液的微小RNA（miRNA）已得到详细研究，并发现其可能是指示肺癌存在的有用生物标志物，特别是用作LDCT的辅助检测时。预计在不久的将来，血液中miRNA和循环肿瘤DNA（ct-DNA）检测将变得更经济实惠，因此这些潜在敏感的方法可在进行LDCT和肺癌确诊诊断检测之前作为一线筛查方式。此外，miRNA不仅可以揭示肿瘤负荷，还可能揭示肿瘤侵袭性、组织学、治疗反应和患者的总体生存期。在不久的将来，ct-DNA分析可能会揭示除表皮生长因子受体（EGFR）之外的体细胞突变、肿瘤负荷以及隐匿性疾病进展情况。理论上，这些生物标志物还可能帮助肿瘤学家阐明肿瘤对放疗的反应，并且在未来，可能协助放射肿瘤学家做出数据驱动的治疗决策，并为患者提供有关其治疗反应的定量信息。
