循环肿瘤DNA液体活检在胃癌诊疗中的应用进展

doi:10.3969/j.issn.1004-583X.2026.05.012

摘要/Abstract

摘要：

胃癌(gastric cancer, GC)是人类健康的重大威胁因素之一,我国是世界上 GC 负担最重的国家,传统经胃镜取活检虽为 GC 诊断的“金标准”,但受限于其有创性、成本高,患者接受度低等原因,诊疗过程中难以通过多次活检监测患者的疾病进展情况及治疗反应。作为液体活检的核心标志物,循环肿瘤DNA因其无创、高效、精准以及可动态分析和实时监测的能力,为 GC 个体化精准治疗方案的制定提供了实时分子依据。本文系统归纳了循环肿瘤DNA液体活检技术的核心原理与发展脉络,重点论述了在 GC 早期筛查诊断、术后复发风险及预后评估、分子残留病灶全程监测、个体化临床治疗指导领域的应用进展,剖析了其临床应用的现存挑战,明确了 GC 诊疗领域的未来发展方向,以期为 GC 临床精准诊疗提供参考依据。

关键词: 胃肿瘤, 液体活检, 循环肿瘤 DNA, 分子残留病灶, 精准诊疗

中图分类号:

R735.2

张志源, 夏娟, 李璎芝, 王东辉, 邓文杰, 张琰. 循环肿瘤DNA液体活检在胃癌诊疗中的应用进展[J]. 临床荟萃, 2026, 41(5): 462-467.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.05.012

https://www.lchc.cn/CN/Y2026/V41/I5/462

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参考文献 48

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对比维度	液体活检	组织活检
样本来源	血液、尿液等体液	肿瘤组织(需内镜或手术)
侵入性	微创(仅需抽血)	有创(需穿刺或手术)
动态监测可行性	可多次采样	不适合频繁操作
肿瘤异质性评估	可整合全身肿瘤克隆的异质性信息	仅能反映取样部位的肿瘤特征,存在漏检风险
术后监测适配性	术后无可见病灶时仍可完成MRD检测	术后无病灶时无法获取检测样本
临床核心场景	早筛、动态疗效监测、MRD复发预警、耐药追踪	初诊病理确诊、基线组织分子分型

对比维度	液体活检	组织活检
样本来源	血液、尿液等体液	肿瘤组织(需内镜或手术)
侵入性	微创(仅需抽血)	有创(需穿刺或手术)
动态监测可行性	可多次采样	不适合频繁操作
肿瘤异质性评估	可整合全身肿瘤克隆的异质性信息	仅能反映取样部位的肿瘤特征,存在漏检风险
术后监测适配性	术后无可见病灶时仍可完成MRD检测	术后无病灶时无法获取检测样本
临床核心场景	早筛、动态疗效监测、MRD复发预警、耐药追踪	初诊病理确诊、基线组织分子分型

体液类型	cfDNA浓度中位数 (μg/L)	主要来源细胞	胃癌临床应用优势
外周血	5~30	造血细胞、内皮细胞、肿瘤细胞	标准化采样流程、高富集度、动态监测可行性
腹腔积液	50~500	腹腔间皮细胞、胃癌腹膜转移灶细胞	肿瘤特异性信号富集,适配胃癌腹膜转移患者的检测与监测
胃灌洗液	10~40	胃黏膜上皮细胞、胃内肿瘤病灶细胞	直接富集病灶来源DNA,适配胃癌早期筛查与病灶定位

体液类型	cfDNA浓度中位数 (μg/L)	主要来源细胞	胃癌临床应用优势
外周血	5~30	造血细胞、内皮细胞、肿瘤细胞	标准化采样流程、高富集度、动态监测可行性
腹腔积液	50~500	腹腔间皮细胞、胃癌腹膜转移灶细胞	肿瘤特异性信号富集,适配胃癌腹膜转移患者的检测与监测
胃灌洗液	10~40	胃黏膜上皮细胞、胃内肿瘤病灶细胞	直接富集病灶来源DNA,适配胃癌早期筛查与病灶定位

循环肿瘤DNA液体活检在胃癌诊疗中的应用进展

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