Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC.
Chest. 2023 Oct;164(4):1028-1041. doi: 10.1016/j.chest.2023.05.025. Epub 2023 May 25.
Lung cancer is the leading cause of cancer-related deaths. Early detection and diagnosis are critical, as survival decreases with advanced stages. Approximately 1.6 million nodules are incidentally detected every year on chest CT scan images in the United States. This number of nodules identified is likely much larger after accounting for screening-detected nodules. Most of these nodules, whether incidentally or screening detected, are benign. Despite this, many patients undergo unnecessary invasive procedures to rule out cancer because our current stratification approaches are suboptimal, particularly for intermediate probability nodules. Thus, noninvasive strategies are urgently needed. Biomarkers have been developed to assist through the continuum of lung cancer care and include blood protein-based biomarkers, liquid biopsies, quantitative imaging analysis (radiomics), exhaled volatile organic compounds, and bronchial or nasal epithelium genomic classifiers, among others. Although many biomarkers have been developed, few have been integrated into clinical practice as they lack clinical utility studies showing improved patient-centered outcomes. Rapid technologic advances and large network collaborative efforts will continue to drive the discovery and validation of many novel biomarkers. Ultimately, however, randomized clinical utility studies showing improved patient outcomes will be required to bring biomarkers into clinical practice.
肺癌是癌症相关死亡的主要原因。早期发现和诊断至关重要，因为随着疾病进展，生存率会下降。在美国，每年胸部 CT 扫描图像中偶然发现约 160 万个结节。考虑到筛查发现的结节，这个数量可能更大。这些结节中的大多数，无论是偶然发现还是筛查发现，都是良性的。尽管如此，许多患者还是接受了不必要的侵入性程序来排除癌症，因为我们目前的分层方法并不理想，尤其是对于中等可能性的结节。因此，迫切需要非侵入性策略。已经开发了生物标志物来协助整个肺癌治疗过程，包括基于血液蛋白的生物标志物、液体活检、定量成像分析（放射组学）、呼出挥发性有机化合物以及支气管或鼻上皮基因组分类器等。尽管已经开发了许多生物标志物，但由于缺乏显示改善以患者为中心的结局的临床实用性研究，很少有生物标志物被整合到临床实践中。快速的技术进步和大型网络协作努力将继续推动许多新型生物标志物的发现和验证。然而，最终需要进行随机临床实用性研究，以显示改善患者结局，才能将生物标志物应用于临床实践。
