新的血液檢測可以確定哪些癌症患者的疾病傳播風險更高

A new blood test could determine which cancer patients have a higher risk of their disease spreading, according to new research. 

The test, developed by British researchers, analyzes fragments of DNA that are shed by tumors into the bloodstream.

In a study on 47 patients with rectal cancer, they found the test accurately predicted whose cancer would spread over the next two year, spotted 74 percent of them before they had even started treatment. 

Experts say the report, presented at a conference today, is encouraging, but time will tell how pivotal it is in the context of countless other studies and start-ups trying to find a liquid biopsy to detect cancer and aggressive cancer early.

根據一項新的研究，一項新的血液檢測可以確定哪些癌症患者的疾病傳播風險更高。

這項由英國研究人員開發的測試分析了腫瘤流入血液中的DNA片段。

在一項針對47名直腸癌患者的研究中，他們發現該測試準確預測了癌症將在接下來的兩年中蔓延，在他們開始治療之前發現了74％。

專家說，今天在一次會議上提交的這份報告令人鼓舞，但時間將證明在無數其他研究和初創企業試圖尋找液體活檢以及早發現癌症和侵襲性癌症的背景下，這是多麼關鍵。

'We know patients respond quite differently to standard treatment - some will do really well, and have what we call a complete pathological response,' lead author Dr Shelize Khakoo, Medical Oncologist at The Royal Marsden NHS Foundation Trust, said. 

'For others, the cancer may spread during treatment.

'If we can predict early on who will go on to develop metastatic disease, we might be able to tailor treatment by making it more intense or trying an alternative.' 

In this study, the researchers took liquid biopsies from 47 patients at The Royal Marsden who had localized rectal cancer, meaning it had not already spread to other body parts. 

Blood samples were taken before, during and after patients had completed chemotherapy and radiotherapy (CRT), and then again after surgery. 

They recorded ctDNA in 74 percent of patients before any treatment, and 21 percent of patients mid-way through CRT, 21 percent after CRT and 13 percent after surgery. 

英國皇家馬斯登NHS基金會信託醫學腫瘤學家Shelize Khakoo博士說，我們知道患者對標準治療的反應完全不同 - 有些人會做得很好，並且我們稱之為完全的病理反應。

“對於其他人來說，癌症可能會在治療期間傳播。

“如果我們能夠及早預測誰將繼續發展為轉移性疾病，我們或許可以通過使治療更加激烈或嘗試替代治療來定制治療方案。”

在這項研究中，研究人員對皇家馬斯登的47名患者進行了液體活檢，這些患者患有局限性直腸癌，這意味著它尚未擴散到其他身體部位。

在患者完成化療和放療（CRT）之前，期間和之後採集血液樣本，然後在手術後再次採集。

在任何治療前，他們在74％的患者中記錄了ctDNA，在CRT中途記錄了21％的患者，CRT後21％，手術後13％。

The ctDNA results at the end of CRT were associated with tumor response to CRT as shown on MRI scans.

Following up around two years later, they found the blood test had been accurate. 

Those with traces of ctDNA were more likely to see their cancer spread beyond the rectum.

Those with ctDNA persisting throughout their treatment were more likely to develop metastatic cancer sooner.  

'These results suggest that liquid biopsies offer us an accurate method of establishing the cancer's activity throughout the body,' said fellow lead author Professor David Cunningham OBE, Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust.

'Importantly what this study showed, which has not yet been explored, is that persistence of ctDNA mid-way through treatment could be an early indicator of the cancer's potential to spread. 

'Using this measure, along with MRI scans, we can offer a more personalized treatment approach for patients.'

Dr Khakoo added: 'Whilst our findings are interesting and exciting, it's important to note that this was carried out in a small cohort of patients and would require further validation in a larger trial.'

如MRI掃描所示，CRT結束時的ctDNA結果與CRT的腫瘤反應相關。

大約兩年後，他們發現血液測試是準確的。

那些有ctDNA痕蹟的人更容易看到他們的癌症擴散到直腸以外。

那些在整個治療過程中持續存在ctDNA的人更有可能更快地發展為轉移性癌症。

“這些結果表明，液體活檢為我們提供了一種準確的方法來確定整個身體的癌症活動，”其他主要作者，皇家馬斯登NHS基金會信託醫學顧問醫學腫瘤學家David Cunningham OBE教授說。

“重要的是，這項尚未探索的研究表明，通過治療中途持續存在ctDNA可能是癌症傳播潛力的早期指標。

“使用這種方法，連同MRI掃描，我們可以為患者提供更個性化的治療方法。”

Khakoo博士補充說：“雖然我們的發現很有趣且令人興奮，但重要的是要注意這是在一小群患者中進行的，需要在更大的試驗中進一步驗證。”