Predicting Response to Treatment in Gastroesophageal Junction Adenocarcinomas: Combining Clinical, Imaging, and Molecular Biomarkers
Predicting Response to Treatment in Gastroesophageal Junction Adenocarcinomas: Combining Clinical, Imaging, and Molecular Biomarkers
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DOI：
10.1634/theoncologist.2009-0293
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发表时间：
2010-01-01
期刊：
影响因子：
5.8
通讯作者：
Petty, Russell D.
中科院分区：
文献类型：
--
作者：
Bain, Gillian H.;Petty, Russell D.
胃食管连接部腺癌（GEJ）的发病率正在迅速上升，即使在早期局部局限性疾病中，5年生存率也很少超过25%-35%。随机试验和荟萃分析已经证明了新辅助或围手术期化疗以及新辅助放化疗的益处。然而，个体患者的最佳方法尚不清楚，仍然存在争议。一个一致的发现是，对新辅助治疗有组织病理学反应的患者更有可能获得生存获益。这些临床数据为迫切发展预测GEJ腺癌新辅助治疗的组织病理学反应的方法提供了强有力的论据。已发表的数据表明，临床病理学特征（肿瘤位置）、成像（氟脱氧葡萄糖-正电子发射断层扫描“代谢反应”）和组织/分子生物标志物都可能对新辅助治疗具有预测价值。然而，从已发表的数据来看，尚不确定它们是否可用于个体患者的临床决策。现有的候选生物标志物需要适当地鉴定和验证，并且需要新的生物标志物;并且最佳方法应该涉及临床、成像和分子生物标志物的组合和整合。本综述介绍了证据基础，并讨论了新的实验方法，生物标志物的方式相结合，以允许优化GEJ腺癌患者的个性化治疗方法，可能是相关的其他肿瘤类型以及。肿瘤学家2010; 15：270-284
The incidence of adenocarcinomas of the gastroesophageal junction (GEJ) is rapidly rising, and even in early-stage locoregional confined disease the 5-year survival rate rarely exceeds 25%-35%. Randomized trials and meta-analyses have demonstrated a benefit with neoadjuvant or perioperative chemotherapy and with neoadjuvant chemoradiotherapy. However, the optimal approach in individual patients is not clear and remains controversial. A consistent finding is that patients who have a histopathological response to neoadjuvant therapy are more likely to receive a survival benefit. These clinical data provide a strong argument for the urgent development of methods to predict histopathological response to neoadjuvant therapies for GEJ adenocarcinoma. Published data demonstrate that clinicopathological features (tumor location), imaging (fluorodeoxyglucose-positron emission tomography "metabolic response"), and tissue/molecular biomarkers may all have a predictive value for neoadjuvant therapies. However, it is uncertain from published data whether or not they will be useful for clinical decision making in individual patients. Existing candidate biomarkers need to be properly qualified and validated and novel biomarkers are required; and an optimal approach should involve the combination and integration of clinical, imaging, and molecular biomarkers. This review presents the evidence base and discusses novel experimental approaches for the combination of biomarker modalities to allow optimization of an individualized treatment approach in GEJ adenocarcinoma patients that may be relevant to other tumor types as well. The Oncologist 2010; 15: 270-284