在临床决策中使用ctDNA的实用建议

SCI

30 July 2023

Practical recommendations for using ctDNA in clinical decision making

 (Nature IF: 49.96)

Cohen SA, Liu MC, Aleshin A. Practical recommendations for using ctDNA in clinical decision making. Nature. 2023;619(7969):259-268. doi:10.1038/s41586-023-06225-y

The continuous improvement in cancer care over the past decade has led to a gradual decrease in cancer-related deaths. This is largely attributed to improved treatment and disease management strategies. Early detection of recurrence using blood-based biomarkers such as circulating tumour DNA (ctDNA) is being increasingly used in clinical practice. Emerging real-world data shows the utility of ctDNA in detecting molecular residual disease and in treatment-response monitoring, helping clinicians to optimize treatment and surveillance strategies. Many studies have indicated ctDNA to be a sensitive and specific biomarker for recurrence. However, most of these studies are largely observational or anecdotal in nature, and peer-reviewed data regarding the use of ctDNA are mainly indication-specific. Here we provide general recommendations on the clinical utility of ctDNA and how to interpret ctDNA analysis in different treatment settings, especially in patients with solid tumours. Specifically, we provide an understanding around the implications, strengths and limitations of this novel biomarker and how to best apply the results in clinical practice.

过去十年来，癌症治疗的不断改进使得癌症相关死亡人数逐渐减少。这主要归功于治疗和疾病管理策略的改进。利用血液中的生物标记物（如循环肿瘤 DNA (ctDNA)）对复发进行早期检测正越来越多地应用于临床实践中。新出现的真实世界数据显示，ctDNA 在检测分子残留疾病和治疗反应监测方面非常有用，有助于临床医生优化治疗和监测策略。许多研究表明，ctDNA 是一种敏感而特异的复发生物标志物。然而，这些研究大多是观察性的或轶事性质的，而有关 ctDNA 应用的同行评审数据主要是针对特定适应症的。在此，我们就ctDNA的临床实用性以及如何在不同的治疗环境中解释ctDNA分析提供一般性建议，尤其是在实体瘤患者中。具体来说，我们将围绕这种新型生物标记物的意义、优势和局限性以及如何将结果最好地应用于临床实践等方面进行阐述。