局部晚期非小细胞肺癌微小残留病灶的研究进展

Research progress in minimal residual ddisieseaasese in in lo locacally advanced non-small cell lung cancer

局部晚期不可手术非小细胞肺癌(NSCLC)的标准治疗为同步放化疗(CCRT)后巩固免疫治疗,但后续可能复发。影像学检查只能被动识别复发、无法提前预测风险,基于循环肿瘤DNA(ctDNA)检测的微小残留病灶(MRD)则成为新兴的肿瘤标志物。研究表明,ctDNA在NSCLC放(化)疗后先升后降,不仅可以预测复发,还可能指导巩固免疫治疗、评估疗效和判断预后,甚至有助于探索其他有效的治疗方案。目前将ctDNA-MRD用于指导巩固治疗相关的临床研究较少、样本量较小、证据等级较低,其临床价值仍需前瞻性随机研究进一步验证。

For locally advanced unresectable non-small cell lung cancer(NSCLC),the standardregimen1is concurrent chemoradiotherapy(CCRT)followed by consolidation immunotherapy.Nevertheless,the majority of patients will experience recurrence.Traditional imaging examination has its limitations of passively identifying recurrence,unable to forecast the risk in advance.Minimal residual disease(MRD)based on circulating tumor DNA(ctDNA)has become a novel tumor biomarker.Existing studies have demonstrated that the levels of ctDNA initially increase and then decrease during CCRT for NSCLC.Monitoring ctDNA-MRD can not only robustly predict recurrence,but also guide the consolidation immunotherapy,evaluate the efficacy and predict clinical prognosis.Furthermore,ctDNA-MRD can be a reliable biomarker to explore other effective treatments.However,few ctDNA-MRD clinical studies related to guiding consolidation therapy have been performed,with small sample size and low-level evidence.The value of ctDNAMRD still needs to be confirmed by prospective randomized studies.