Petrillo Angelica, Smyth Elizabeth C
Medical Oncology Unit, Ospedale del Mare, Naples, Italy.
University of Study of Campania L. Vanvitelli, Naples, Italy.
Visc Med. 2020 Oct;36(5):364-372. doi: 10.1159/000510489. Epub 2020 Sep 25.
Gastric cancer (GC) is one of the most lethal cancers worldwide. Although GC was historically considered a single entity within the organ of origin, nowadays it is acknowledged that GC represents a heterogeneous disease. Nevertheless, in this field there is still a lack of biomarkers able to guide the choice of the best treatment options for each patient. This review aims to summarize the prognostic and predictive biomarkers evaluated in GC and their role as a guide for treatment for precision medicine.
Human epidermal growth factor receptor 2 overexpression represents the only predictive molecular biomarker validated in GC, while its prognostic role is still controversial. Microsatellite instability and Epstein-Barr virus status are promising for prediction of the response to immunotherapy. The role of other biomarkers (ctDNA, programmed death ligand 1 [PD-L1], and TMB), as well as the practical application of molecular classifications, requires further evaluation before use in clinical practice. 18-FDG-PET scan could be useful as a predictive tool in non-metastatic GC patients receiving a perioperative approach. Finally, the tumor microenvironment may have an evolving role in the future.
GC is a heterogeneous disease and targeted approaches are needed. The finding of prognostic and predictive factors is a hot topic in the field of GC personalized medicine.
胃癌（GC）是全球最致命的癌症之一。尽管胃癌在历史上被认为是起源器官内的单一实体，但如今人们认识到胃癌是一种异质性疾病。然而，在该领域仍缺乏能够指导为每位患者选择最佳治疗方案的生物标志物。本综述旨在总结在胃癌中评估的预后和预测生物标志物及其作为精准医学治疗指南的作用。
人表皮生长因子受体2过表达是胃癌中唯一经证实的预测性分子生物标志物，但其预后作用仍存在争议。微卫星不稳定性和爱泼斯坦-巴尔病毒状态有望预测免疫治疗的反应。其他生物标志物（循环肿瘤DNA、程序性死亡配体1 [PD-L1]和肿瘤突变负荷）的作用以及分子分类的实际应用，在临床实践中使用前需要进一步评估。18氟脱氧葡萄糖正电子发射断层扫描在接受围手术期治疗的非转移性胃癌患者中可能作为一种预测工具。最后，肿瘤微环境在未来可能会发挥不断演变的作用。
胃癌是一种异质性疾病，需要靶向治疗方法。预后和预测因素的发现是胃癌个性化医学领域的热门话题。
