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Review
. 2020 Feb 12;4(3):216-223.
doi: 10.1002/ags3.12317. eCollection 2020 May.

Application of liquid biopsy for surgical management of pancreatic cancer

Minako Nagai  1 , Masayuki Sho  1 , Takahiro Akahori  1 , Kenji Nakagawa  1 , Kota Nakamura  1
Affiliations
Review

Application of liquid biopsy for surgical management of pancreatic cancer

Minako Nagai et al. Ann Gastroenterol Surg. .

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest forms of cancer. Although drug development over the past decade has gradually improved the prognosis of PDAC, the prognosis remains extremely poor. The predominant determinant of a poor prognosis is that patients are already at the advanced stage when they are diagnosed. Therefore, it is essential to detect early-stage PDAC to ensure a good prognosis. However, in general, being asymptomatic at the early stage makes the detection of early-stage PDAC very difficult. Recently, much attention has been focused on the utility of a liquid biopsy as a biomarker. Theoretically, early-stage tumors can be detected even under asymptomatic conditions. A number of studies on liquid biopsies have been reported so far. Several biomarkers, including circulating tumor DNA (ctDNA), circulating tumor cells (CTCS), and exosomes, are used in liquid biopsies, with the potential to be applied to the clinical setting. Each biomarker is reported to have different utilities, such as the detection of early-stage disease, the differential diagnosis of PDAC from other types of pancreatic tumors, the prediction of the prognosis or risk of recurrence, and monitoring the treatment response. In this review, we focus on ctDNA, CTCS, and exosomes as representative liquid biopsy biomarkers and describe the specific functions of each biomarker in the treatment of PDAC. Furthermore, we discuss the application of liquid biopsies, especially for the surgical management of PDAC.

Keywords: circulating tumor DNA; circulating tumor cells; exosomes; liquid biopsy; pancreatic ductal adenocarcinoma.

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Conflict of interest statement

Funding: None. Conflict of Interest: The authors declare no conflicts of interest for this article. Author Contribution: Masayuki Sho devised the main conceptual idea and proof outline. Minako Nagai selected and reviewed references, wrote the initial draft of this manuscript. Takahiro Akahori, Kenji Nakagawa, and Kota Nakamura helped review the references and assisted in the presentation of this manuscript.

Figures

Figure 1
Figure 1
The cells shed various materials into the body fluid. The tumor‐derived components such as circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), exosomes are released from tumor cells, as well as apoptotic or necrotic cells. And they are correlated with the formation of distant metastasis. They are useful as biomarkers for liquid biopsy because they contain the tumor genetic information
Figure 2
Figure 2
CTCs reflect therapeutic response sensitively. If we evaluate the therapeutic effect frequently during treatment by examining CTCs as a biomarker, it may be possible to change the chemotherapy regimen without delay, and the patients will not miss the opportunity to undergo surgery
See this image and copyright information in PMC

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