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桓兴医讯 癌症患者的循环肿瘤DNA分析:《美国临床肿瘤学会》和《
文章来源:北京市朝阳区桓兴肿瘤医院 点击数: 发布时间:2018-03-13 15:07
美国《临床肿瘤学杂志》2018年3月5日在线先发
癌症患者的循环肿瘤DNA分析:《美国临床肿瘤学会》和《美国病理医生协会》联合分析
目的
在循环肿瘤DNA(ctDNA)中评价基因变异的分析检查,临床上的应用在不断增多,这项出自ASCO和《美国病理医生协会》的联合分析,总结了临床上ctDNA检查的最新信息,为今后的研究提供了一个基本框架。
方法
专家组进行了一项实体瘤ctDNA检查应用情况的文献分析,文献分析纳入了预分析变量、分析验证、解释和汇总、临床验证及应用。
结果
文献检索甄别出1338篇参考文献。选择其中390篇,外加专家组提供的31篇文献,阅读全文,(然后)选择出77篇文章纳入分析。
结论
有证据表明,最好在有细胞稳定剂或EDTA的试管中采集的血浆上实施ctDNA检查,应在EDTA试管采集后6小时内进行检查。在某些类型的晚期癌症中,有些ctDNA检测证明临床有效、实用,但在晚期癌症中,绝大多数ctDNA检测的临床有效性和实用性证据不足。有证据表明,ctDNA检测和肿瘤标本的基因分型之间,结果不一致;有证据支持对肿瘤组织进行基因分型,来核实ctDNA检查未检测出的结果。在癌症早期、治疗监测或残留病灶检测中,ctDNA检查没有临床实用性的证据,也几乎没有ctDNA检测有效性的证据。ctDNA检查对于癌症筛查、临床试验以外的应用,没有临床有效性和临床实用性的证据。鉴于研究进展之快,随着检测工具的研发和临床实践的指导,很快将需要对文献进行再评价。
北京市朝阳区桓兴肿瘤医院 桓兴医讯编译组 吉雪
2018年3月13日 星期二
Circulating Tumor DNA Analysis in Patients With Cancer: American Society of Clinical Oncology and College of American Pathologists Joint Review
http://ascopubs.org/doi/full/10.1200/JCO.2017.76.8671
Purpose
Clinical use of analytical tests to assess genomic variants in circulating tumor DNA (ctDNA) is increasing. This joint review from ASCO and the College of American Pathologists summarizes current information about clinical ctDNA assays and provides a framework for future research.
Methods
An Expert Panel conducted a literature review on the use of ctDNA assays for solid tumors, including pre-analytical variables, analytical validity, interpretation and reporting, and clinical validity and utility.
Results
The literature search identified 1,338 references. Of those, 390, plus 31 references supplied by the Expert Panel, were selected for full-text review. There were 77 articles selected for inclusion.
Conclusion
The evidence indicates that testing for ctDNA is optimally performed on plasma collected in cell stabilization or EDTA tubes, with EDTA tubes processed within 6 hours of collection. Some ctDNA assays have demonstrated clinical validity and utility with certain types of advanced cancer; however, there is insufficient evidence of clinical validity and utility for the majority of ctDNA assays in advanced cancer. Evidence shows discordance between the results of ctDNA assays and genotyping tumor specimens and supports tumor tissue genotyping to confirm undetected results from ctDNA tests. There is no evidence of clinical utility and little evidence of clinical validity of ctDNA assays in early-stage cancer, treatment monitoring, or residual disease detection. There is no evidence of clinical validity and clinical utility to suggest that ctDNA assays are useful for cancer screening, outside of a clinical trial. Given the rapid pace of research, re-evaluation of the literature will shortly be required, along with the development of tools and guidance for clinical practice.

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