肺癌的液態活檢

Liquid Biopsy in Lung Cancer

10.6314/JIMT.2017.28(6).03

楊福雄(Fu-Hsiung Yang)；湯旭南(Shiu-Nan Tang)

肺癌(Lung cancer) ； 腫瘤的異質性(Tumor heterogenicity) ； 液態活檢(Liquid biopsy) ； 循環腫瘤去氧核醣核酸(Circulating tumor DNA, ctDNA) ； 循環腫瘤細胞(Circulating tumor cell, CTC) ； 腫瘤化血小板(Tumor educated platelets, TEP) ； 胞外泌體(Exosomes)

內科學誌

28卷6期（2017 / 12 / 01）

334 - 343

繁體中文

肺癌(lung cancer)是全球相關癌症致死的主要原因之一，大約佔了癌症相關死亡人數的四分之一。推究主要原因是發現時大部分都是晚期，就算目前推行的低劑量胸部電腦斷層檢查能降低相關肺癌致死率20%，但是高的偽陽性導致不必要的侵入性組織切片檢查。隨著分子醫學技術的發展，目前針對癌症的檢查已經從傳統的病理檢驗擴展到基因分子醫學的領域，了解到越來越多的疾病，包括癌症也是異質性的疾病(tumor heterogenicity)，所以單一次的組織病理切片檢查不能表達整個腫瘤的樣貌；液態活檢(liquid biopsy)可以補充組織病理檢驗提供非侵入性、即時性、重複性的檢查，本文中將介紹相關的生物標記：循環腫瘤去氧核醣核酸(circulating tumor DNA, ctDNA)、循環腫瘤細胞(circulating tumor cell, CTC)、腫瘤化血小板(tumor educated platelets, TEP)及胞外泌體(exosomes)，最後在探討液態活檢在肺癌的臨床相關運用。

Lung cancer is the leading cause of deaths from cancer worldwide, accounting for almost one-quarter of fatalities. The overwhelming majority of these victims die due to a late diagnosis. Despite the powerful tool with low-dose computed tomography (LDCT) reduces the risk of death by 20%, the false positive finding of LDCT or overdiagnosis could lead to unnecessary invasive tissue biopsy and harmful management. With the advancement in the identification of molecular and protein-based tumor biomarkers, the current cancer screen has been extended from traditional pathological examination to genomics in order to understand more and more pathogenesis of the heterogenous characteristic in cancer. A single tissue biopsy can't represent the appearance of the entire tumor. However, liquid biopsy can complement the histopathological examination to provide a noninvasive, immediate and reproducible specimen. In this paper, we introduce the relevant biomarkers in liquid biopsy: circulating tumor DNA, circulating tumor cell, tumor educated platelets, and exosomes. Finally, we discuss the incorporation of liquid biopsy and clinical practice of lung cancer.