Cell-free Nucleic Acid as Promising Diagnostic Biomarkers for Gastric Cancer: a Systematic Review

Area of Science:

• Oncology
• Molecular Diagnostics
• Biomarker Discovery

Background:

• Gastric cancer (GC) is a prevalent malignancy where early detection significantly impacts patient survival.
• Liquid biopsy, utilizing cell-free nucleic acids, is an emerging and preferred method for non-invasive cancer detection.
• Assessing the diagnostic accuracy of these biomarkers is crucial for clinical application.

Purpose of the Study:

• To systematically review and evaluate the diagnostic efficacy of cell-free nucleic acid markers for gastric cancer detection.
• To compare the performance of cell-free RNAs (cfRNAs) and cell-free DNAs (cfDNAs) as diagnostic markers for GC.

Main Methods:

• Systematic literature search of PubMed and ISI Web of Science databases (2012-2022).
• Inclusion of studies reporting diagnostic indicators (sensitivity, specificity, AUC, P-value) for cfRNA and cfDNA markers in GC.
• Abstraction of study characteristics including marker type, specimen, and diagnostic performance metrics.

Main Results:

• Fifty-eight studies analyzed cfRNAs (62 individual markers, 7 panels) and 21 studies analyzed cfDNAs (29 individual markers, 7 panels).
• Individual cfRNAs showed median sensitivity of 80% and specificity of 80%; cfRNA panels had 86% sensitivity and 75% specificity.
• Individual cfDNAs demonstrated median sensitivity of 50% and specificity of 93%; cfDNA panels had 85% sensitivity and 73.5% specificity.
• Meta-analysis indicated cfRNAs have high sensitivity (80%) but lower specificity (80%), whereas cfDNAs have lower sensitivity (59%) but higher specificity (92%).

Conclusions:

• Cell-free nucleic acids, including cfRNAs and cfDNAs, hold significant potential as diagnostic markers for gastric cancer.
• cfRNAs exhibit superior sensitivity, while cfDNAs offer higher specificity in GC detection.
• Combining cfRNA and cfDNA markers may enhance the overall diagnostic efficiency for gastric cancer.