Translational Research Center in Onco-Hematology, Department of Medicine, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.
Swiss Cancer Center Léman, 1005 Lausanne, Switzerland.
Cells. 2023 Jan 26;12(3):413. doi: 10.3390/cells12030413.
The treatment of locally advanced rectal cancer (LARC) requires a multimodal approach combining neoadjuvant radiotherapy or chemoradiotherapy (CRT) and surgery. Predicting tumor response to CRT can guide clinical decision making and improve patient care while avoiding unnecessary toxicity and morbidity. Circulating biomarkers offer both the advantage to be easily accessed and followed over time. In recent years, biomarkers such as proteins, blood cells, or nucleic acids have been investigated for their predictive value in oncology. We conducted a comprehensive literature review with the aim to summarize the status of circulating biomarkers predicting response to CRT in LARC. Forty-nine publications, of which forty-seven full-text articles, one review and one systematic review, were retrieved. These studies evaluated circulating markers (CEA and CA 19-9), inflammatory biomarkers (CRP, albumin, and lymphocytes), hematologic markers (hemoglobin and thrombocytes), lipids and circulating nucleic acids (cell-free DNA [cfDNA], circulating tumor DNA [ctDNA], and microRNA [miRNA]). Post-CRT CEA levels had the most consistent association with tumor response, while cfDNA integrity index, MGMT promoter methylation, ERCC-1, miRNAs, and miRNA-related SNPs were identified as potential predictive markers. Although circulating biomarkers hold great promise, inconsistent results, low statistical power, and low specificity and sensibility prevent them from reliably predicting tumor response following CRT. Validation and standardization of methods and technologies are further required to confirm results.
局部晚期直肠癌（LARC）的治疗需要采用多模态方法，结合新辅助放疗或放化疗（CRT）和手术。预测肿瘤对 CRT 的反应可以指导临床决策，改善患者的治疗效果，同时避免不必要的毒性和发病率。循环生物标志物具有易于随时间获取和跟踪的优势。近年来，蛋白质、血细胞或核酸等生物标志物已被用于研究其在肿瘤学中的预测价值。我们进行了全面的文献综述，旨在总结预测 LARC 患者 CRT 反应的循环生物标志物的现状。共检索到 49 篇文献，其中 47 篇全文文章、1 篇综述和 1 篇系统评价。这些研究评估了循环标志物（CEA 和 CA 19-9）、炎症标志物（CRP、白蛋白和淋巴细胞）、血液学标志物（血红蛋白和血小板）、脂质和循环核酸（游离 DNA [cfDNA]、循环肿瘤 DNA [ctDNA] 和 microRNA [miRNA]）。CRT 后 CEA 水平与肿瘤反应的相关性最一致，而 cfDNA 完整性指数、MGMT 启动子甲基化、ERCC-1、miRNA 及其 miRNA 相关 SNP 被确定为潜在的预测标志物。尽管循环生物标志物具有很大的应用前景，但结果不一致、统计效能低以及特异性和敏感性低，使其无法可靠地预测 CRT 后的肿瘤反应。需要进一步验证和标准化方法和技术，以确认结果。
