Nurczyk Kamil, Nowak Norbert, Carlson Rebecca, Skoczylas Tomasz, Wallner Grzegorz
2(nd) Department of General Surgery, Medical University of Lublin, Lublin, Poland.
2(nd) Department of General Surgery, Medical University of Lublin, Lublin, Poland.
Adv Med Sci. 2023 Mar;68(1):138-146. doi: 10.1016/j.advms.2023.02.005. Epub 2023 Mar 20.
Multimodal treatment is the standard of care in patients with locally advanced gastric cancer. Unfortunately, the response rate after neoadjuvant treatment remains limited. The ability to predict the response has a potential to improve patient outcomes by promoting a more individualized approach. We sought to describe the current state of research in pre-treatment molecular biomarkers of response to neoadjuvant therapy in gastric adenocarcinoma available for testing before the initiation of treatment and to perform a systematic review and meta-analysis in order to summarize and evaluate the potential methods.
A systematic MEDLINE, EMBASE and CENTRAL literature search was conducted to extract articles on potentially predictive molecular biomarkers of pathological response to neoadjuvant therapy in patients with gastric- and esophago-gastric junction adenocarcinoma. Fixed and random effects models were used to undertake the meta-analysis when appropriate.
Data on predictive biomarkers was reported in 38 studies. These articles described 47 biomarkers showing statistical significance. After evaluation of all reported biomarkers, 3 of them met the inclusion criteria for meta-analysis. The meta-analysis results indicate that >5 ng/mL pre-therapeutic serum concentration of carcinoembryonic antigen (CEA; norm <5 ng/mL) is significantly associated with tumor response (RR = 5.13, 95% CI 2.53-10.43, P = 0.026).
Previous studies describe a large number of candidate biomarkers. Our meta-analysis indicated pre-therapeutic serum concentration of CEA >5 ng/mL as a potential and easy-accessible biomarker available for use before initiation of treatment. However, it could be only an additional tool for complex qualification for neoadjuvant therapy.
多模式治疗是局部晚期胃癌患者的标准治疗方法。遗憾的是，新辅助治疗后的缓解率仍然有限。预测缓解情况的能力有可能通过采用更个体化的方法来改善患者的治疗结果。我们试图描述在胃癌腺癌新辅助治疗反应的治疗前分子生物标志物方面的研究现状，这些标志物可在治疗开始前进行检测，并进行系统评价和荟萃分析，以总结和评估潜在的方法。
进行了系统的MEDLINE、EMBASE和CENTRAL文献检索，以提取关于胃和食管胃交界腺癌患者新辅助治疗病理反应的潜在预测分子生物标志物的文章。在适当的时候使用固定效应模型和随机效应模型进行荟萃分析。
38项研究报告了预测生物标志物的数据。这些文章描述了47种具有统计学意义的生物标志物。在评估所有报告的生物标志物后，其中3种符合荟萃分析的纳入标准。荟萃分析结果表明，治疗前血清癌胚抗原（CEA；正常<5 ng/mL）浓度>5 ng/mL与肿瘤反应显著相关（RR = 5.13，95%CI 2.53 - 10.43，P = 0.026）。
先前的研究描述了大量候选生物标志物。我们的荟萃分析表明，治疗前血清CEA浓度>5 ng/mL是一种潜在的、易于获取的生物标志物，可在治疗开始前使用。然而，它可能只是新辅助治疗复杂评估的一个辅助工具。
