Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press132310.17650/1726-9776-2020-16-3-174-189REVIEWОБЗОРPotential clinical application of free-circulating DNA from blood in renal cancerКлинический потенциал использования свободно циркулирующей в крови ДНК при раке почкиhttps://orcid.org/0000-0002-0107-5413YakubovichE. I.ЯкубовичЕ. И.
Russian Federation

70 Leningradskaya St., Pesochnyy, Saint-Petersburg 197758.

Якубович Елена Игоревна.197758 Санкт-Петербург, пос. Песочный, Ленинградская ул., 70.

jakubovichelena@mail.ruPolishchukA. G.ПолищукА. Г.
Russian Federation

70 Leningradskaya St., Pesochnyy, Saint-Petersburg 197758.

Полищук Анна Генриховна.197758 Санкт-Петербург, пос. Песочный, Ленинградская ул., 70.

apolishchuk@rrcrst.ruEvtushenkoV. I.ЕвтушенкоВ. И.
Russian Federation

70 Leningradskaya St., Pesochnyy, Saint-Petersburg 197758.

Евтушенко Владимир Иванович.197758 Санкт-Петербург, пос. Песочный, Ленинградская ул., 70

mol-biol@yandex.ruA.M. Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Health of RussiaРоссийский научный центр радиологии и хирургических технологий им. акад. А.М. Гранова Минздрава России300920201631741890707202025082020https://oncourology.abvpress.ru/oncur/article/view/1323

Early diagnosis of renal cancer carcinoma is a key determinant of patient survival. The asymptomatic disease course and lack of reliable diagnostic markers lead to the fact that more than 30 % renal cancer cases discovered at an advanced stage, when the prognosis is poor because kidney tumors are resistant to standard chemotherapy and radiation. More than 30 % of renal cancer carcinoma recur or metastasize after surgical treatment. Despite the implementation of novel targeted drugs and immune point inhibitors, the 5-year survival rate for metastatic renal cancer carcinoma remains dismal. Unsatisfactory result of renal cancer treatment may be caused by high inter- and intra-tumor heterogeneity and tumor evolution during therapy, as well as the lack of predictive and on-treatment monitoring biomarkers. Liquid biopsy test that utilizes free-circulating DNA (cfDNA) in the blood of patients, opens up new opportunities for managing patients with renal cancer. The diagnostic and predictive potential of these minimally invasive biomarkers has been demonstrated for various types of cancer. The use of highly sensitive methods of cfDNA analysis may allow early cancer detection and prediction of postoperative disease recurrence before dinical and radiographic progression. Serial cfDNA samples, that were collected before and during course of treatment, can provide information about the dynamic mutational changes in the volume of the entire tumor and metastases in real time, and the emergence of drug resistance during treatment. This information may be promising toolfor optimizing patient-specific therapeutic strategies. This review is focusing on the potential clinical application of cfDNA from blood in renal cancer.

 

Ранняя диагностика карциномы почки является ключевым фактором, определяющим выживаемость пациентов. Бессимптомное течение и отсутствие надежных диагностических маркеров приводят к тому, что более чем в 30 % случаев заболевание выявляется на продвинутой стадии, когда прогноз неблагоприятен, поскольку опухоли почки устойчивы к стандартной химиотерапии и облучению. Более чем у 30 % пациентов с локализованными опухолями после нефрэктомии развиваются рецидивы и метастазы. Несмотря на внедрение новых таргетных и иммунотерапевтических методов лечения, показатели 5-летней выживаемости при метастатической карциноме почки остаются неудовлетворительными. Среди возможных причин низкой эффективности лечения могут быть высокая межопухолевая и внутриопухолевая гетерогенность и эволюция опухоли на фоне терапии, а также отсутствие предиктивных биомаркеров ответа на терапию. Новые возможности ведения пациентов с раком почки открывает жидкостная биопсия, основанная на тестировании свободно-циркулирующей ДНК (сцДНК) в крови пациентов. Диагностический и предиктивный потенциал этих малоинвазивных биомаркеров продемонстрирован для различных типов рака. Использование высокочувствительных методов анализа сцДНК позволяет выявить заболевание на ранних стадиях и предсказать развитие постоперационного рецидива до появления клинических и радиографических изменений. Последовательные образцы сцДНК, собранные до и в процессе лечения, дают возможность в режиме реального времени контролировать динамику мутационных изменений в объеме всей опухоли и метастазах, а также возникновение резистентности в ходе лечения. Эта информация может стать полезным инструментом для оптимизации персонализированных терапевтических стратегий. В данном обзоре рассматривается потенциал клинического использования сцДНК для пациентов с раком почки.

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