基于循环肿瘤DNA的分子残留病灶检测及其在非小细胞肺癌术后中的应用价值

ctDNA-based MRD detection and its application value in non-small cell lung cancer after surgery

肺癌仍是我国乃至全世界发病率、病死率较高的恶性肿瘤之一,其中主要以非小细胞肺癌(NSCLC)为主。目前以手术为主的综合治疗仍是早中期及局部晚期的NSCLC的标准治疗方法,但仍有很多ⅠA~ⅢA期病人在根治性治疗后复发。因此临床上对精准的根治性手术治疗后的监测手段和辅助治疗的评估方法有强烈的需求,以达到根除分子残留病灶(MRD)。随着检测技术的进步,循环肿瘤DNA(ctDNA)作为提示MRD的分子指标逐步走向临床。最新共识提出在将围手术期NSCLC病人外周血中可稳定检测出的ctDNA作为MRD的检测指标。MRD的应用使得对NSCLC根治术后进行疾病监测、以判断预后和更早地发现肿瘤复发成为可能。在早中期及局部晚期的NSCLC病人术后辅助治疗研究中,不同的研究结果表明术后辅助治疗的疗效及判断是否需要行术后辅助治疗的标准存在争议。MRD可以作为一个更精准的预测指标,有望对术后辅助治疗进行指导,并为精准的个体化辅助治疗方案的制定提供依据,从而使病人能在疾病治疗中获益。

Lung cancer remains one of the malignant tumours with high incidence and mortality in China and worldwide,with nonsmall cell lung cancer(NSCLC)being the main type of cancer.Surgery-based combination therapy is still the standard treatment for early to mid-stage and locally advanced NSCLC,but there are still many patients with stageⅠA-ⅢA recurrence after radical treatment.There is therefore a strong clinical demand for accurate monitoring tools and adjuvant treatment assessment methods after radical surgical treatment to achieve eradication of molecular residual disease(MRD).With the advances in detection technology,circulating tumor DNA(ctDNA)is increasingly being used as a molecular indicator of MRD.The latest consensus proposes the use of stably detectable ctDNA in peripheral blood of patients with perioperative NSCLC as a test for MRD.The use of MRD has made it possible to monitor disease after radical NSCLC surgery for prognosis and earlier detection of tumour recurrence.In studies of post-operative adjuvant therapy in early to mid-stage and locally advanced NSCLC patients,the efficacy of post-operative adjuvant therapy and the criteria for determining the need for post-operative adjuvant therapy have been controversial in different studies.MRD can be used as a more accurate predictor that is expected to guide postoperative adjuvant therapy and provide a basis for precise individualized adjuvant treatment planning so that patients can benefit from the treatment of their disease.