Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Acta Oncol. 2022 Apr;61(4):523-530. doi: 10.1080/0284186X.2022.2033831. Epub 2022 Feb 9.
This article reviews the current knowledge on circulating tumor DNA (ctDNA) in early stage colon cancer and ongoing trials on ctDNA-guided treatment in the adjuvant setting.
A literature search of Pubmed was performed to identify studies on ctDNA in early stage colon cancer and neoadjuvant or adjuvant treatment. For ongoing trials, we searched clinicaltrials.gov and the Australian New Zealand Clinical Trials Registry (ANZCTR).
Several studies show that ctDNA is a strong predictor for recurrence and survival after surgery and adjuvant chemotherapy. The specificity of this marker is extremely high, and the sensitivity is increasing with the development of technology. Recurrences can be detected very early and the analysis can potentially be used to guide neoadjuvant and adjuvant treatment. Ongoing and planned studies are now looking into escalation and de-escalation of therapy according to ctDNA-status after surgery.
Serial measurement of ctDNA shows great promise as a marker for both prognosis and response to treatment in early colon cancer. Future studies will show whether we can use this analysis for tailoring treatment for patients in the adjuvant and neoadjuvant setting. With improved technology, ctDNA has the potential of becoming a 'game-changer' in the treatment of early stage colon cancers.
本文综述了循环肿瘤 DNA（ctDNA）在早期结肠癌中的现有知识，以及正在进行的基于 ctDNA 的辅助治疗试验。
在 Pubmed 上进行文献检索，以确定有关早期结肠癌和新辅助或辅助治疗中 ctDNA 的研究。对于正在进行的试验，我们在 clinicaltrials.gov 和澳大利亚新西兰临床试验注册中心（ANZCTR）上进行了搜索。
几项研究表明，ctDNA 是手术后和辅助化疗后复发和生存的强有力预测因子。该标志物的特异性极高，随着技术的发展，其灵敏度也在不断提高。可以非常早期地检测到复发，并且该分析有可能用于指导新辅助和辅助治疗。目前正在进行的和计划中的研究正在根据手术后的 ctDNA 状态，研究治疗的升级和降级。
ctDNA 的连续测量显示出作为早期结肠癌预后和治疗反应的标志物的巨大潜力。未来的研究将表明，我们是否可以将这种分析用于辅助和新辅助治疗中患者的治疗。随着技术的改进，ctDNA 有可能成为治疗早期结肠癌的“游戏规则改变者”。
