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Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2022; 28(46): 6478-6496
Published online Dec 14, 2022. doi: 10.3748/wjg.v28.i46.6478
Liquid biopsy leads to a paradigm shift in the treatment of pancreatic cancer
Fumiaki Watanabe, Koichi Suzuki, Hiroshi Noda, Toshiki Rikiyama
Fumiaki Watanabe, Koichi Suzuki, Hiroshi Noda, Toshiki Rikiyama, Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
Author contributions: All authors contributed to the design of the study. Watanabe F and Suzuki K drafted the manuscript and analyzed data; All other authors contributed to the manuscript review; The final version of the manuscript was read and approved by all authors.
Supported by Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology, No. JP 16K10514; and the JKA Foundation through its promotion funds from the Keirin Race, No. 27-1-068 (2).
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fumiaki Watanabe, MD, PhD, Assistant Professor, Doctor, Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Minuma-ku, Saitama 330-8503, Japan. fwatanabe@jichi.ac.jp
Received: September 20, 2022
Peer-review started: September 20, 2022
First decision: October 18, 2022
Revised: October 25, 2022
Accepted: November 21, 2022
Article in press: November 21, 2022
Published online: December 14, 2022
Abstract

Pancreatic ductal adenocarcinoma (PDAC) is one of the most cancers. Its 5-year survival rate is very low. The recent induction of neoadjuvant chemotherapy and improvements in chemotherapy for patients with pancreatic cancer have resulted in improved survival outcomes. However, the prognosis of pancreatic cancer is still poor. To dramatically improve the prognosis, we need to develop more tools for early diagnosis, treatment selection, disease monitoring, and response rate evaluation. Recently, liquid biopsy (circulating free DNA, circulating tumor DNA, circulating tumor cells, exosomes, and microRNAs) has caught the attention of many researchers as a new biomarker that is minimally invasive, confers low-risk, and displays an overall state of the tumor. Thus, liquid biopsy does not employ the traditional difficulties of obtaining tumor samples from patients with advanced PDAC to investigate their molecular biological status. In addition, it allows for long-term monitoring of the molecular profile of tumor progression. These could help in identifying tumor-specific alterations that use the target structure for tailor-made therapy. Through this review, we highlighted the latest discoveries and advances in liquid biopsy technology in pancreatic cancer research and showed how it can be applied in clinical practice.

Keywords: Pancreatic cancer, Cell-free DNA, Circulating tumor DNA, Circulating tumor cells, Exosomes, MicroRNAs

Core Tip: We focused on liquid biopsy technology for pancreatic ductal adenocarcinoma (PDAC), including circulating free DNA, circulating tumor DNA, circulating tumor cells, exosomes, and microRNAs. We equally described the characteristics of these technologies and reviewed the clinical significance according to the purpose of these biomarkers: early diagnosis, prognosis, prediction of recurrence, and therapeutic response. Although liquid biopsy still has many limitations to its widespread utilization in clinical practice, liquid biopsy has the potential to be applied from diagnosis to treatment. It is expected to improve the prognosis of PDAC radically.