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液体活检:分子与临床肿瘤学中的 hype 与 hope。

Liquid Biopsy, the hype vs. hope in molecular and clinical oncology.

机构信息

Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.

Advanced Medical Research Institute, Bhubaneswar, Odisha, India; CORE Diagnostics, Gurgaon, Haryana, India.

出版信息

Semin Oncol. 2021 Jun;48(3):259-267. doi: 10.1053/j.seminoncol.2021.06.002. Epub 2021 Jul 14.

Abstract

The molecular landscape of tumors has been traditionally established using a biopsy or resection specimens. These modalities result in sampling bias that offer only a single snapshot of tumor heterogeneity. Over the last decade intensive research towards alleviating such a bias and obtaining an integral yet accurate portrait of the tumors, evolved to the use of established molecular and genetic analysis using blood and several other body fluids, such as urine, saliva, and pleural effusions as liquid biopsies. Genomic profiling of the circulating markers including circulating cell-free tumor DNA (ctDNA), circulating tumor cells (CTCs) or even RNA, proteins, and lipids constituting exosomes, have facilitated the diligent monitoring of response to treatment, allowed one to follow the emergence of drug resistance, and enumerate minimal residual disease. The prevalence of tumor educated platelets (TEPs) and our understanding of how tumor cells influence platelets are beginning to unearth TEPs as a potentially dynamic component of liquid biopsies. Here, we review the biology, methodology, approaches, and clinical applications of biomarkers used to assess liquid biopsies. The current review addresses recent technological advances and different forms of liquid biopsy along with upcoming challenges and how they can be integrated to get the best possible tumor-derived genetic information that can be leveraged to more precise therapies for patient as liquid biopsies become increasingly routine in clinical practice.

摘要

肿瘤的分子特征传统上是通过活检或切除标本建立的。这些方法会导致采样偏差,只能提供肿瘤异质性的单一快照。在过去的十年中,人们致力于缓解这种偏差,并通过使用血液和其他几种体液(如尿液、唾液和胸腔积液)作为液体活检来获得肿瘤整体而准确的特征,从而进行了深入的研究。对循环标志物的基因组分析,包括循环游离肿瘤 DNA(ctDNA)、循环肿瘤细胞(CTC)甚至 RNA、蛋白质和构成外泌体的脂质,促进了对治疗反应的仔细监测,允许跟踪耐药性的出现,并计数最小残留疾病。肿瘤教育血小板(TEP)的流行以及我们对肿瘤细胞如何影响血小板的理解,开始揭示 TEP 作为液体活检的一个潜在动态成分。在这里,我们回顾了用于评估液体活检的生物标志物的生物学、方法学、方法和临床应用。本综述介绍了最近的技术进步和不同形式的液体活检以及即将出现的挑战,以及如何整合它们以获得尽可能好的肿瘤衍生遗传信息,这些信息可用于更精确的治疗,因为液体活检在临床实践中变得越来越常规。

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