O'Dowd Darragh, O'Sullivan Jacintha, Marcone Simone
Department of Surgery, Trinity Translational Medicine Institute, Trinity St. James's Cancer Institute, Trinity College Dublin, St. James's Hospital, D08 W9RT Dublin, Ireland.
Cancers (Basel). 2022 Jul 14;14(14):3427. doi: 10.3390/cancers14143427.
Oesophageal adenocarcinoma (OAC) incidence has increased dramatically in the developed world, yet outcomes remain poor. Extensive endoscopic surveillance programs among patients with Barrett's oesophagus (BO), the precursor lesion to OAC, have aimed to both prevent the development of OAC via radiofrequency ablation (RFA) and allow earlier detection of disease. However, given the low annual progression rate and the costs of endoscopy/RFA, improvement is needed. Prognostic biomarkers to stratify BO patients based on their likelihood to progress would enable a more targeted approach to surveillance and RFA of high-risk precursor lesions, improving the cost-risk-benefit ratio. Similarly, diagnostic biomarkers for OAC could enable earlier diagnosis of disease by allowing broader population screening. Current standard treatment for locally advanced OAC includes neoadjuvant chemotherapy (+/- radiotherapy) despite only a minority of patients benefiting from neoadjuvant treatment. Accordingly, biomarkers predictive of response to neoadjuvant therapy could improve patient outcomes by reducing time to surgery and unnecessary toxicity for the patients who would have received no benefit from the therapy. In this mini-review, we will discuss the emerging biomarkers which promise to dramatically improve patient outcomes along the BO-OAC disease sequence.
在发达国家，食管腺癌（OAC）的发病率急剧上升，但治疗效果仍然不佳。作为OAC的前驱病变，巴雷特食管（BO）患者广泛接受内镜监测，目的是通过射频消融（RFA）预防OAC的发生，并实现疾病的早期检测。然而，鉴于年进展率较低以及内镜检查/RFA的成本，仍需改进。基于进展可能性对BO患者进行分层的预后生物标志物，将有助于对高危前驱病变进行更有针对性的监测和RFA，提高成本-风险-效益比。同样，OAC的诊断生物标志物可通过更广泛的人群筛查实现疾病的早期诊断。目前，局部晚期OAC的标准治疗包括新辅助化疗（±放疗），尽管只有少数患者能从新辅助治疗中获益。因此，预测新辅助治疗反应的生物标志物可以通过减少手术时间和避免对无治疗获益患者的不必要毒性，来改善患者的治疗效果。在本综述中，我们将讨论有望显著改善BO-OAC疾病进程中患者治疗效果的新兴生物标志物。
