Jacobson Richard A, Munding Emily, Hayden Dana M, Levy Mia, Kuzel Timothy M, Pappas Sam G, Masood Ashiq
Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA.
Division of Hematology/Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL 60612, USA.
Cancers (Basel). 2019 Aug 13;11(8):1164. doi: 10.3390/cancers11081164.
Room for improvement exists regarding recommendations for screening, staging, therapy selection, and frequency of surveillance of gastrointestinal cancers. Screening is costly and invasive, improved staging demands increased sensitivity and specificity to better guide therapy selection. Surveillance requires increased sensitivity for earlier detection and precise management of recurrences. Peripherally collected blood-based liquid biopsies enrich and analyze circulating tumor cells and/or somatic genomic material, including circulating tumor DNA along with various subclasses of RNA. Such assays have the potential to impact clinical practice at multiple stages of management in gastrointestinal cancers. This review summarizes current basic and clinical evidence for the utilization of liquid biopsy in cancers of the esophagus, pancreas, stomach, colon, and rectum. Technical aspects of various liquid biopsy methodologies and targets are reviewed and evidence supporting current commercially available assays is examined. Finally, current clinical applicability, potential future uses, and pitfalls of applying liquid biopsy to the screening, staging and therapeutic management of these diseases are discussed.
在胃肠道癌症的筛查、分期、治疗选择及监测频率等方面仍有改进空间。筛查成本高且具有侵入性，改进分期需要提高敏感性和特异性以更好地指导治疗选择。监测需要提高敏感性以便更早发现复发并进行精确管理。外周血液体活检可富集并分析循环肿瘤细胞和/或体细胞基因组物质，包括循环肿瘤DNA以及各种RNA亚类。此类检测方法有可能在胃肠道癌症管理的多个阶段影响临床实践。本综述总结了目前利用液体活检诊断食管癌、胰腺癌、胃癌、结肠癌和直肠癌的基础及临床证据。回顾了各种液体活检方法和靶点的技术方面，并审视了支持当前商用检测方法的证据。最后，讨论了目前液体活检在这些疾病的筛查、分期及治疗管理中的临床适用性、潜在的未来用途及陷阱。
