doi:10.16150/j.1671-2870.2019.06.020

Abstract

CLC Number:

R735.2
735.3

Figures/Tables 2

References 68

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肿瘤标志物	肿瘤类型	检测手段	临床应用
CEA	结肠癌、胰腺癌、胃癌、肝癌等	放射免疫分析法、酶联免疫吸附试验检测血清、脑脊液、乳汁、胃液、胸腹水及尿液、粪便等多种体液和排泄物	连续监测CEA,可用于手术后、化疗不同时期的疗效观察,灵敏度和特异度不高
CA19-9	胰腺癌、肝胆系癌、胃癌、 CRC等	酶联免疫吸附试验检测血清样本	胰腺癌患者85%~95% CA19-9为阳性,肿瘤切除后浓度会下降,再上升则可表示复发;CRC、胆囊癌、胆管癌、肝癌和胃癌的阳性率高,同时检测 CEA和AFP可进一步提高阳性率
HER2 c-MET K-RAS	胃癌（扩增或过度表达）胃癌、结肠癌(扩增或过度表达) 结肠癌 (突变)	酶联免疫分析、酶联免疫吸附试验、化学发光免疫分析法等检测血清样本	靶向治疗预后和预测因素,HER2是胃食管腺癌的治疗靶点
MSI-H dMMR	胃癌、CRC 胃癌、CRC	免疫组织化学	dMMR对结肠癌、胃癌和胰腺癌患者的生存有积极的预后,并可预测PD-1抑制剂抗癌疗效

肿瘤标志物	肿瘤类型	检测方法	临床应用
肿瘤微环境		免疫组织化学、流式细胞仪分析
PD1/PDL1 肿瘤浸润淋巴细胞免疫抑制性骨髓细胞	广谱癌结肠癌和胃癌胰腺癌、肝癌和胃癌		选择对抗PD-1/PD-L1疗法反应佳的患者. FDA批准了PD-1单抗O药nivolumab和K药pembrolizumab用于治疗PD-L1表达阳性的胃癌,作用机制是阻断PD-1和PD-L1之间的相互作用PD-L1抗体atezolizumab T药在结直肠癌等中有效提示预后良好提示预后不良较多数量的骨髓细胞,包括骨髓来源的抑制细胞、中性粒细胞、单核细胞,是肿瘤免疫治疗预后较差的标志
肿瘤基因组学
靶基因panels TMB	广谱癌广谱癌	新一代测序 TMB计算(每1Mb蛋白编码区的平均突变个数)	适合用于分析某些功能集合的基因或基因区域,预测和判断疾病表型 DNA修复系统出现问题会导致DNA损伤突变的积累,即TMB升高,而较高的非同义突变负荷预示免疫治疗将有较好的客观缓解率,适用于TMB高、对抗PD-1/PD-L1疗法有反应的患者人群
液体活检
ctDNA CTC 外泌体	胃肠道恶性肿瘤	血浆ctDNA靶向深度测序免疫细胞化学法、流式细胞仪分析、核酸检测法超速离心法、试剂盒提取法	胃结肠癌的早期筛查和诊断、治疗疗效的判断、预后的分析,指导晚期肿瘤患者选择药物,监测微小残余病灶早期检测CTC可辅助临床诊断、预测临床疗效和预后,实现多次、实时监测肿瘤转移、复发及耐药肿瘤早期诊断标志物,提示肿瘤的残留、进行性发展或复发,预估治疗反应

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