Esophageal cancer (EC) is one of the leading causes of cancer-related deaths globally. Surgery is the standard treatment for resectable EC after preoperative chemoradiotherapy or chemotherapy, followed by postoperative adjuvant chemotherapy in certain cases. Upper gastrointestinal endoscopy and computed tomography (CT) are predominantly performed to evaluate the efficacy of these treatments, but their sensitivity and accuracy for evaluating minimal residual disease remain unsatisfactory, thereby requiring the development of alternative methods. In recent years, interest has been increasing in using liquid biopsy to assess treatment responses. Liquid biopsy is a noninvasive technology for detecting cell components in the blood and other body fluids. It involves collecting a small sample of body fluid, which is then analyzed for the presence of components, including circulating tumor DNA (ctDNA), microRNA (miRNA), or circulating tumor cells (CTCs). Further, ctDNA and miRNA are analyzed with various techniques, including digital polymerase chain reaction (dPCR) and next-generation sequencing (NGS). CTCs are isolated by determining surface antigens using immunomagnetic techniques or by filtering the blood according to cell size and rigidity. Several studies indicate that investigating these materials helps predict EC prognosis and recurrence and possibly stratifies high-risk groups. Liquid biopsy may also apply to the selection of cases that have achieved a complete response through preoperative treatment to prevent surgery and preserve the esophagus, as well as identifying the suitability of postoperative chemotherapy and the timing of conversion surgery for unresectable EC. The potential of liquid biopsy to enhance treatment decisions will further advance EC treatment.
食管癌是全球癌症相关死亡的主要原因之一。对于可切除食管癌，术前放化疗或化疗后手术是标准治疗方案，部分病例术后还需辅助化疗。目前主要依靠上消化道内镜和计算机断层扫描评估治疗效果，但这些方法对微小残留病灶的检测敏感性和准确性仍不理想，因此需要开发替代方法。近年来，利用液体活检评估治疗反应的研究日益增多。液体活检是一种无创技术，通过检测血液及其他体液中的细胞成分实现。该技术通过采集少量体液样本，分析其中是否存在循环肿瘤DNA、微小RNA或循环肿瘤细胞等成分。进一步可采用数字聚合酶链式反应、新一代测序等技术分析循环肿瘤DNA和微小RNA，而循环肿瘤细胞则通过免疫磁珠技术检测表面抗原或根据细胞大小和刚性进行血液过滤分离。多项研究表明，对这些生物标志物的研究有助于预测食管癌的预后和复发风险，并可能实现高危人群分层。液体活检还可用于筛选术前治疗达到完全缓解的病例以避免手术并保留食管功能，同时有助于判断术后化疗的适用性及不可切除食管癌转化手术的时机。液体活检在优化治疗决策方面的潜力将推动食管癌治疗的进一步发展。
Liquid Biopsy and Multidisciplinary Treatment for Esophageal Cancer
肿瘤(癌症)患者之家