This study was conducted by Kezhong Chen (Department of Thoracic Surgery, Peking University People’s Hospital and Institute of Thoracic Oncology, Peking University People’s Hospital). In clinical practice, traditional tumor-node-metastasis (TNM) staging was difficult to achieve accuracy in stratifying prognosis at the individual patient level. Therefore, the researchers proposed to introduce blood minimal residual disease (MRD) status and proposed a novel tumor-node-metastasis-blood (TNMB) staging system to more accurately and individually define the postoperative status of lung cancer patients (Fig. 1).
LB technology, well known for its noninvasiveness, easy access, reproducibility, and ability to comprehensively and dynamically display tumor data, has promising potential in early detection, treatment assessment, prognosis, and recurrence monitoring of non-small cell lung cancer (NSCLC). In recent years, with the rapid advances and developments of these technologies, LB technology has shown promise as a novel approach to overcome the clinical bottlenecks described above.
The low dropout rate of LB biomarkers, the existence of background noises such as clonal hematopoiesis, and the lack of unified standards are still challenges. Here, we present a comprehensive overview of the technical updates implemented to address the above-mentioned issues and propose an innovative and practical approach for the precise management of NSCLC after LB integration.
Biomarkers such as circulating tumor cells (CTCs) and exosomes, which possess unique characteristics while sharing a common lipid bilayer structure and containing abundant genetic and proteomic information protected by this bilayer, overlap in the techniques for enriching and distinguishing these vesicles. Cell-free DNA (cfDNA)-based genetic information detection methods can be classified into PCR-based and next-generation sequencing (NGS)-based approaches. The researchers summarized the methods used in the current study to increase the genetic information detection rate and improve accuracy (Fig. 2).
Researchers proposed the development of a TNMB staging system that integrates blood information to improve the current TNM cancer staging system. This novel component will promote further advances in precision oncology. In the past, due to methodological limitations, many false negatives occurred, and existing clinical trials were designed solely based on TNM staging or MRD detection. However, the use of customized panels and the development of sequencing techniques, as exemplified by the PROPHET study, have significantly improved the detection sensitivity and validated the advanced nature and efficiency of integrating liquid biopsy information into the TNMB tumor staging scheme. Therefore, if the technology can be standardized, it is conceivable that future clinical trials can be built based on TNMB staging (Fig. 3). It is expected that with the advancement of the development of detection mechanisms and technology, LB technology will gradually be accepted in the management of NSCLC.
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